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possible reasons for poor vision after macular hole closure
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possible reasons for poor vision after macular hole closure

I had  a vitrectomy, gas bubble, face down in February for a macular hole.   Seven months later I still have 3 white opaque splotches that prevent me from reading, etc.  They appear to be like clouds.  They get a LITTLE BIT smaller each month.  I had previous cataract surgery with IOL 3 years.  The white spots are similar in appearance to the cataracts.  My retinal specialist/surgeon has no idea, he says, maybe cell damage.  He tried steroids for the last 6 weeks with minimal improvement.  Please give me a few suggestions as to what this might be.
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Dear gigs924,

It might be some residual damage or swelling in the macula.  Sometimes, swelling in the macula may take time to resolve. I have seen some patients which have swelling which take 14 months to improve. Perhaps, you could perform a test known as Amsler grid testing, to look at a grid, to detect the damage and see its improvement over time.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California
16 Comments
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Avatar_n_tn
I have the same effect after first having a vitrectomy done (July, 2007) for a macular hole/tear and recently, cataract surgery (July, 2008) to replace my lens. My vision is "cloudy" as well. I am going back to the Cataract surgeon tomorrow and will be referred back to the retinal specialist for further investigation. The Cataract surgeon also said that it could be cell damage as a result of the vitrectomy to repair the hole.
I will continue to post as well.
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Avatar_n_tn
Thank you so much for your reply.  I feel so alone about this and would like some definite answer as to WHY this happened. I am considering going to Barnes in St. Louis for a second opinion.  I would really appreciate knowing your followup.
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Avatar_n_tn
Futher follow up to my appointment today with the Cataract surgeon. He did an in-office laser treatment (YAG?) to see if there was any "fogging" as a result of the cataract surgery. I won't know until tomorrow if that helped. It was very minor and took a couple of minutes and I had to wait in the office for 20 minutes to insure that the eye pressure didn't increase as a result of the procedure. No pressure increase, so I went back to work. I am now to see the retinal expert that did the vitrectomy a year ago for more follow up. I am not that optimistic about clearing the vision as my holeee/tear was in the middle of my vision and I was told before the Vitrectomy that this may occur.
I will continue to post my progress and would like to know how you progress as well.
Have a great day:
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Avatar_n_tn
I had macular hole surgery Feb. 2008 and have an opaque/dark circle in my central vision and I have had no improvement for months. It is very difficult to read, write, cut and perform many other fine motor tasks. Depth perception doesn't always cooperate for me but I challenge myself each day with these activities, tasks, etc.which  I use to take for granted. I am healthy, eat well, take vitamins, don't smoke or drink and followed every direction post-op the surgeon gave me and still did not have a successful outcome.
I try to be positive that I will have even a slight bit of improvement in that eye.
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Avatar_n_tn
What does your surgeon tell you about possible improvement or the reason for your vision outcome?  Does your other eye have good vision?  I read somewhere in these posts someone continued to have improvement at 14 months.  Can we hope?
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Avatar_n_tn
One surgeon states  4 weeks will be the likely outcome of your sight but with a very slight chance of improvement in the future and another surgeon states a gradual improvement within a year. It appears with this surgery and all the research and reading I have done, the outcome is extremely unpredictable. All surgeons pre-surgery were highly positive about a successful outcome.
Although I ask I have never been given a clear answer to why I have no central vision. I try to remain hopeful, as it would be a major blessing.
I have the beginning of a cataract on the same eye and I am not sure where this will lead.
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Avatar_n_tn
Where did you read a possible improvement up to a year?  My surgeon says 3 months is tops.  Looking for some hope.
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Avatar_n_tn
The surgeon who performed my surgery after a 4 month visit stated that it is possible to continue to have improvement up to a year after surgery and I have read of cases on web sites where some patients did have some gradual improvement within a year of surgery. Again, there seems to be various outcomes depending on the patient healing, size of hole and location, which would stand to reason why the Dr.'s can not commit to an outcome because we are all such individual patients with varying diagnoses.

We would love to have a Dr. from this forum to comment.
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Avatar_f_tn
Of course, we are individual, and the process apparentky does not happen at at the same rate for all, as some other processes approximately do--but has no one done research to get some statistics for the patients to see what is sometimes possible, the average, and even the most disappointing of outcomes?

One of you could possibly google it, to see what is available?
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Avatar_f_tn
I apologize. I missed a post--you already have researched this. Yet I guess it is hard to believe one still may improve in time, and to hear so many different comments from doctors. I experienced the same thing with my retina.. I wonder if there are any specific conditions that allow a person to make progress as late as months, as Dr. Feldman says?

I am just trying to be helpful, I know what kind of heartbreak this uncertainty brings. I never knew what to expect with my retina. For a while, it looked like I would have the very worst possible outcome--losing my eye, and I was beyond terrified. But things have turned around, or maybe I got some uncaring opinions. I also have a new doctor now.

I wish the best for all of you.

Anna.
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Avatar_f_tn
Dr. Feldman also says 14 months.
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Avatar_n_tn
An observation I have noted is all magazines, health books, etc. make reference to Eye Health, Eye Care, etc. but when you read the article there is no reference to a macular hole. Recently, a magazine caught my attention with an article on Eye Care At Every Age, so of course I purchased it hoping I would read about macular holes but once again I was disappointed with no mention of this disorder. So, is it safe to state that macular holes are fairly uncommon, there hasn't been enough research on this topic, the surgery is fairly new, not recognized, ???? It concerns me because we as macular hole patients are continually asking and seeking information which is not readily available, even from our health professionals.
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Avatar_f_tn
I had surgery for a macular hole in January of 2007 and was without vision in the affected eye for about 3 monts. I still have distortion and waviness in the vision in tht eye.  I have very poor depth perception now. I had cataract removal in April of 2008and had some initial vision improvement (especially my depth perception) after the cataract surgery, but now the vision in the affected eye is worsening again.  The cataract surgeon says it could be from a "clouding" of the lens, but is sending me back to the retina specialist for a consult.  The cataract surgeon says the cloudiness can be removed with lasar surgey.  I will post again after I see the retina specialist.  It does seem like there are not many answers.
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Avatar_f_tn
My retina specialist did and OTC and an angiogram of the eye.  He says there is "leakage" in the back of the eye that is distorting my vision as this leakage blocks the macula.  He says this is a common side effect ot cataract surgery.  I am back on eye drops for 6 weeks and then he will re-test.  The saga continues.
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Avatar_n_tn
My retinal surgeon dismissed me with "This is the end.  I cannot do anything else for you"and walked out the door and referred me back to my opthamologist after my last check-up.  Wonder where they learn such compassion!!!!!!!!!!!!
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