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blurry / worse vision after macular pucker surgery
Hello,
I recently undergone a vitrectomy to peel the membrane for macular pucker 3 days ago. My doctor put gas bubble that was supposed to last for 3 days. Since I have a longer eyeball than normal, the gas bubble is still there, however, drops to about 30%.
My concern is vision is constantly worse than before surgery. Before the operation, my vision is 20/200, but that is due to the distortion in the central vision, everything is very clear. However, now, the bubble has gone down below my central vision, everything above the bubble remains cloudy, i can only recognize hand movement, not even count my finger.
Doctor please let me know if this is normal for a typical case of membrane peel.
Also, anyone who has this procedure done before, please help me share your recovery experience. I am very worried now. I had vitrectomy before for retinal detachment, however, as the bubble went down, I was able to see clear on top of it, also, immediately the day after the RD surgery, even with the bubble in full shape, I was able to count finger (in fact, i could see the tiny dust particles on my glasses very clearly). I dont know what happens this time.
Thank you very much for any opinions.
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177275 tn?1438375244
At this point it is not possible to tell you about the final vision you will have. However as long as any of the gas bubble is there it will blur and distort your vision even if its is below "straight ahead".    There is much written on the healing from this type of surgery. Use the search feature and archives to read the many informative posts on the healing process and experience of scores of people after ERM surgery.  It will take probably 4 months to have a good idea of the result.
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Thank you Dr. Hagan, do you think that edema induced after surgery might be causing the problem.
And can ERM peeling result in blindness? If yes, what is the possible reason you can think of for it?
I have a certain degree of cataract (not too much) before the surgery, so I am not sure if it's partially caused by cataract forming, however, part of me thinking that it's too fast for the cataract to advance to the point of not being able to see my hand in front of my eye just 3 days after surgery.  
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177275 tn?1438375244
Generally the air bubble blurs vision a lot more than macular edema (swelling).  Ending in blindness would be very unusual and would likely only occur if there were a massive infection in the eye.  Your cataract will grow much faster now because of this surgery.  In the 'informed consent" permission you signed and in your discussions it would have been listed that any vitreous surgery almost always causes a cataract or makes an existing cataract grown faster.  Just so you know ERM surgery is not like cataract surgery. The results will not be known for months and virtually no-one has clear vision at 3-4 days.
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Thank you so much Dr. Hagan, I really appreciate your insight. I know it is too soon to tell. My doctor did discuss with me about the expedition of cataract after this surgery. I am just trying to figure out why my vision deteriorated to the point of light recognition only, given that my specialist told me the surgery went very well.
A lot of people went to have macular pucker surgery hoping to fix their distortion, but I initially did it because my doctor said it might keep pulling on the retinal and cause another RD. I never try to be greedy and only hope to just remove the scar tissue so that RD won't come back and i can live with the distortion for years to come. Otherwise, i would not take any risk.
Through the discussion from people who has ERM in this forum, I came to know a lot of people started to see again to some level as the bubble came off. I was so worried because my vision is like looking through milk, even when putting my finger a few inches away, i could not see anything, like I am completely blind now.  Hopefully, my vision will not stay that way forever. Oh and, I don't think I have any infection as of now since I took care of eye very carefully and there is no discharge so far.
I think I just wait until I see my RS in a week and hope for the best. I think I'll ask him more in details about the procedure that has been done (dye used for ILM, gas injected, cataract level, any bleeding during the surgery when pulling on the retina, maybe the presence of vascular occlusion?, any infection and edema). Do you think those are good questions?    
I really appreciate your time giving free advise to patients especially at time like this, we patients do not always think straight and everything seems so "cloudy".

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177275 tn?1438375244
I would suggest you call your retina surgeon tomorrow Monday, express your concern to the staff and ask if they can see you sooner.  That is not unreasonable and something that patients do in our practice all the time.
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Thank you Dr. Hagan, my surgeon is not available to see me for tomorrow so I'll call the staff and they have me come in tomorrow with another doctor just to make sure everything is good. I will keep you posted.
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177275 tn?1438375244
Good luck
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Hello Dr. Hagan, turned out I have a lot bleeding in the operated eye. I'm not sure if it's vitreous hemorrhage? The doctor i spoke with told me my vision will take more time for the blood to be filtered out, about 3-4 weeks. They also did an ultrasound to make sure there was no retinal detachment. I'm a little worried since small retinal tears might go unnoticed under ultrasound and might be a reason for bleeding. Right after surgery, I noticed a batch in my central vision whenever i blinked (it'll go away after a second a so), doctor said that was blood, but its position does not change so I think probably the retinal was hurt from the macular peeling, and i want to think it's normal and takes time to heal. So now my concern is: 1. Is there any way to accurately and timely detect retinal problems after vitrectomy to trwat macular pucker. 2. I used to take vitamin Ocuvit, vit E, fish oil, gingo biloba, turmeric+garlic, but now I strongly consider not using anything since all the drug is associated with bleeding. My main reason to take those is because of the anti inflammation effect since doctor told me to prevent the inflammation (i used to have adema lasted for 3 months after first RD surgery). In your opinion, will the benefit of taking vits outweighs the side effects, which one is more dangerous:rhemorage or inflammation. Or should i go like this: giving 3 weeks off-supplement for the blood to clear, then resume supplement one after another when the vitrous clears.
Thank you in advance for your reply.
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177275 tn?1438375244
You should know for certain that you have a vitreous hemorrhage. If you are not certain of that you should call their office to confirm.   Ultrasound would show retinal detachment but not small tears without detachment.  Hold off on any medications not absolutely necessary that can cause bleeding.  You should ask your surgeon these questions as I cannot examine your eye.
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Dear Dr. Hagan, today my surgeon took a look of my eye and did the B-scan ultrasound (said he might be able to see the retina when things cleared up a little more.)
He said the problem of not being able to see out of my eye now is because of cataract and inflammation. Before surgery, I had minor cataract that allowed me to see everything very clearly, but immediately after surgery 7 days ago till now, I would not even count fingers close up. There is no gas bubble left but still residual blood in my eye resulted from the surgery that is clearing up. So i guess, my worsened vision is a combination of blood, cataract and inflammation. Do you think cataract can be worsened that much in a short period of time (2-3 days)?
And so now, I am faced with cataract surgery down the road. I know you wrote about the cataract before and I need a second opinion on my eye. My doctor discussed there is 2 ways since my eye was so highly myopic (-15 on both). In both scenarios, he'll operate on the affected eye, leaving a minor myopia. But with the other eye:
1st option is to wear contact lens over the fellow eye which I prefer. 2nd option is to have lasik on that eye to bring its prescription down to maybe 7 or so, and with additional contact lens to fix the rest. I'm just wondering what is your opinion. I'm concerned about having lasik done can increase the risk of retinal detachment and increase complication in any operations on that eye. Just want to add that, I'm very comfortable wearing glasses, which are like a protection against injury to me. So I'm totally fine if cataract surgery brings me down to -3 to -5. I just want to keep my vision as it is.  
Thank you so much in advance for your opinion.    
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177275 tn?1438375244
It is not likely that cataract would have gotten 'real bad' in 2-3 days unless it was injured during the original surgery (capsule cut).  Normally it takes months to several years for the cataract to become a problem.  I think you situation is too complex to propose a course of action to you but I would suggest you get other opinions before having surgery on either eye.  Yes lasik does carry a risk of RD unless surface laser is done or if the new SMLE (Smile  small incision  lenticule extraction) surgery is done.   You are not going to have to worry about your eyes working together until the eye that has just had the surgery is seeing much better. Suggest you consider not doing anything to good eye till bad eye out of the woods.
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Thank you so much Dr. Hagan, I will take your advise and seek opinion from another doctor. Do you know any good doctors in Florida (North Florida would be better) that has extensive experience doing cataract on highly myopic patients?
And I am sorry if this is a stupid question but I never heard of capsule rupture before. In my situation, should I be worried about that?  
My last question is if cataract should be done soon, how long I could delay it since surgery after surgery might be really bad for the eye. Doctor told me my cataract now is about 2.5 to 3 out of 4, compared to the level of vision loss I'm experiencing, I strongly think that other factors (inflammation, blood) might play remarkable role in it and time will definitely tell a clearer story. I would also like to add that my vision is extremely blurry/cloudy on 1 side and doctor told me that my cataract is worsen on 1 side.
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177275 tn?1438375244
Of course U of Miami, Bascome Palmer Institute is one of the finest in the nation. If that is too far U of FLA  Dept of Ophthalmology Gainseville is good.   During surgery on the back of the eye such as macular hole surgery it is possible to cut or damage the lens of the eye causing a rapidly advancing cataract. Cataract surgery is almost never an emergency and would usually be done only after the back of the eye has settled down and blood gone.
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Thank you Dr. Hagan, I will look more into those institutes. Again, I really appreciate your time to help me a lot during this time.
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177275 tn?1438375244
Best of luck. You have a difficult situation and need the best possible care.
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Dr. Hagan, would you please introduce me the best doctor in/close to Houston for my case. Also, do you know any specific doctor with good reputation in Bascom and UF. I plan to seek at least 3 opinions for my complicated problems. Thank you very much.
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177275 tn?1438375244
Baylor, U of TX,   Texas Retina Associates all have good reputations. I do not know anyone personally that I could introduce you to at Bascom Palmer or UF.   They are very good places so usually well trained and carefully chosen.
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I have residual cystoid macular edema in my operative (left) eye and it doesn't seem to affect my vision much if at all.  Regarding the post-vitrectomy formation of a cataract, it took about a year for mine to get to the point of needing surgery.
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177275 tn?1438375244
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Hello Dr. Hagan, turned out I have a lot bleeding in the operated eye. I'm not sure if it's vitreous hemorrhage? The doctor i spoke with told me my vision will take more time for the blood to be filtered out, about 3-4 weeks. They also did an ultrasound to make sure there was no retinal detachment. I'm a little worried since small retinal tears might go unnoticed under ultrasound and might be a reason for bleeding. Right after surgery, I noticed a batch in my central vision whenever i blinked (it'll go away after a second a so), doctor said that was blood, but its position does not change so I think probably the retinal was hurt from the macular peeling, and i want to think it's normal and takes time to heal. So now my concern is: 1. Is there any way to accurately and timely detect retinal problems after vitrectomy to trwat macular pucker. 2. I used to take vitamin Ocuvit, vit E, fish oil, gingo biloba, turmeric+garlic, but now I strongly consider not using anything since all the drug is associated with bleeding. My main reason to take those is because of the anti inflammation effect since doctor told me to prevent the inflammation (i used to have adema lasted for 3 months after first RD surgery). In your opinion, will the benefit of taking vits outweighs the side effects, which one is more dangerous:rhemorage or inflammation. Or should i go like this: giving 3 weeks off-supplement for the blood to clear, then resume supplement one after another when the vitrous clears.
Thank you in advance for your reply.
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177275 tn?1438375244
I think my posting above answered all your questions.  I don't think any of those supplements will help you.
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