Vitrectomy/ERM

[LazarGroup]

I am a 74 year old, one-eyed patient and have a thick, puckered membrane and 20/60 vision currently. I had a rapid drop in vision from 20/25 to 20/40 to 20/60 within 2 months. I had laser surgery to correct cataract and glaucoma about 3 years ago. I then developed pvd about a year ago. I have been told I am a candidate for a membrane peel and am naturally concerned about the after effects on patients. I need help assessing the risk/reward to the vision of my one eye.  I would be having surgery at John Hopkins. I would appreciate any EyeMDs out there commenting as well as any patients who have actually undergone this surgery with post operative pluses or minuses comments on this complex, and scary surgery to me, . Please answer asap because I have to nake a decision soon. I am a writer and have much left to do and must not lose my vision. I am otherwise healthy and active.

[JodieJ]

I had surgery to peel an ERM two years ago.  My results were mostly positive.  The surgery improved my acuity in my affected eye from about 20/50 to 20/20+, although my retina will never be perfect.

You say that your surgery will be done at Johns Hopkins, but you did not say WHO would be doing it.  I would very strongly advise you against letting a resident or fellow perform this procedure.  My surgery was done at the University of Chicago, which is also a teaching hospital.  My surgeon promised me that he would perform the surgery himself, and he kept his promise.  (And I knew this because I had chosen to skip the sedation and was able to actually watch the surgery being performed.  But don't worry, local anesthesia and IV sedation are the norm--you'll undoubtedly sleep through it.)  In my case, older vitrectomy equipment which requires suturing was used, and my surgeon left this task to his fellow and resident, who obviously needed more experience.  I suffered from weeks of inflammation and steroid treatment as a result of incorrectly placed sutures.  My best advise:  Do not allow a resident or fellow to participate in ANY aspect of your procedure.  This is delicate surgery, although it is neither painful nor terribly dangerous if performed by someone skilled and experienced.  If you are scheduled to see a resident or fellow at Johns Hopkins, I would get another opinion from an experienced retinal specialist in private practice.  

[stefano26]

JodieJ:  I saw this comment.  Could you please tell us what type of doctor TO ask for and define resident or "fellow."  I understand that a resident would still be learning the craft but I don't get the 'fellow" reference.

What should this person and someone else (for instance, myself, if needed) request.

[John C Hagan III, MD, FACS]

After medical school a physician becomes a intern for one year. Then as they specilize they take a residency and are "residents" for ophthalmology this is 3 years. After they finish residency most Eye MDs go into practice. Some seek more training or what is called a "Fellowship" and they are called "Fellows (even the girls)". A Fellowship is generally one or two more years.

You would need to clarify that the main part of the surgery the stripping of the membrane would be done by the "Attending Physician" who is either a full time faculty or a retinal specialist that teaches part time. In most instances this will not be a problem and your preference will be marked on the operating permit.

JCH III MD

[JodieJ]

I admit that I'm prejudiced, but based on my experience I'd want my eye surgeon to be over 40 years old with 10+ years of experience.  Under no circumstances would I want a student (i.e., resident or fellow) doing my surgery, including suturing.  I guess there'd be an upper age limit, but that might vary with the person.