ERM surgery procedure ?

[duane54]

I've seen a Retina specialist about my ERM problem which occurred immediately after cararact surgery where a Rezoom iol was implanted.  Vision is now 20/80 and very blurry in this eye.  Specialist first recomends a Vitrectomy with macular peel- may need a gas bubble but this will be determined while in surgery.  Secondly, wait for results of ERM surgery to follow up on Rezoom vision problems so frequently noted herein.    Specialist has performed approx. two of these surgeries per week for 20 years and as best I can determine is highly recommended.    My questions are:  A) do these recommendations seem reasonable to you   B) based on results- is this the best operating precedure for ERM surgery.  Will appreciate your reply.  Thanks so much.  

[JodieJ]

It's been my impression that specialists in cataract/IOL don't always use the same vocabulary, priorities, or standards for judging outcome as retinal specialists do.  For example, retinal specialists seem to judge surgical success by the ability to read an eye chart with the affected eye; cataract surgeons also consider such factors as contrast sensitivity and binocular vision issues.  I suspect that most retinal specialists would focus first on the ERM in duane54's case; explanting the ReZoom would probably be viewed as a secondary concern.

Dr. Hagan, I think you make a good case for doing an explant procedure first and then re-evaluating.  My own research suggests that even the best ERM surgery never results in a perfect retina (although acuity may be excellent).  And an implant like ReZoom with multiple zones of vision is likely to greatly magnify any residual retinal problems.  So even in the best case scenario, it's likely that duane54 would want a monofocal implant.

  

[John C Hagan III, MD, FACS, FAAO]

Your problem is likely related to your cataract surgery, the development of swelling of the macula (cystic macular edema-CME) and then the epiretinal membrane (ERM). I would suggest seeking a second opinion from another retina specialist. You need to know if there is still CME, and another question is whether to take the problem plaqued ReZoom IOL out FIRST and replace it with the highly successful Tecnis monofocal IOL. You could go through all the huge retina procedures, still have bad problems from the ReZoom and then have to have the ReZoom taken out.

I think there is a strong case for taking the ReZoom out first. Get more opinions.

JCH III MD