20931005 tn?1694139995

Macular Pucker

I had surgery in 2016 for a horseshoe-shaped tear in my retina. It caused me to have a macular pucker. At first, it wasn't a big deal but steadily over a couple of years, it has gotten very bad. My eye doctor thought I had a retina hole and sent me to a retina doctor who assured me I had a pseudo hole, I still couldn't see well but now it's crazy. If I close my bad eye I can see good. However, with both eyes open what I see is a ghosting image. Or if I close my good eye what I see is tilted so that one side is higher than the other. I now cannot drive or do any phone or computer work, without wearing a patch over my bad eye.

Fast forward to what my ophthalmologist suggests I do is see a surgeon. He insists that he would send his mother to get this surgery. I shouldn't but I googled the epi-membrane retina peel that is the procedure I would need to have. If you research what this entails it sounds awful. They have to remove all the gel from inside your eyeball and peel off the membrane. But I see that if they do this when the pucker came from a previous surgery the chances of the retina tearing completely and causing blindness is great. I keep wondering if I should just live with how it is now and forget it or get the surgery.
Best Answer
233488 tn?1310693103
That is a decision only you can make.  Left untreated the ERM may cause a full thickness hole that will leave the central vision worse than it is now.  Informed conscent for surgery is always scary because it must include worse possible scenario.  Think about if every time you get in your car, someone had to explain, that you could get killed, crippled, burned, paralyzed, etc. You would still get in the car and drive because those chances are small expecially driving safely.  Another risk, actually a liklihood is that if you have your natural lens it will form a cataract that often grows fast and requires cataract surgery.   Given this is not an uncommon scenario in ophthalmology most people proceed with a highly trained and regarded retina/vitreous surgeon.
I don’t know the exact surgery you had on the horseshoe tear, but I had such a horseshoe tear laser-repaired in my retinal specialist’s office in 2015 while there to schedule outpatient surgery for macular pucker. It was a long day.

The outcome for the ERM peel/vitrectomy was outstanding in my case, and as Dr. Hagan mentioned I had the expected cataract formation 18 months later. Vision today in that eye with contacts is 20/15 to 20/20.
I had the surgery on September 28th. I went well and they placed an air bubble to hold my thin retinas. At 3 in the morning, after the nerve block had worn off, I awoke to excruciating pain.  I already had a follow-up scheduled the following day and was told that my cornea must have been scratched during surgery. I had been so bandaged up that there was no way I could have scratched it. I now have a contact lens in my eye.  My eye looks like shredded meat all along the edges and super bloodshot. The good news was the follow-up showed the pucker was gone along with the pseudohole.  Still in pain but nothing like it was before they put the lens in my eye.
I have a question, do they put saline in your eye to help hold its shape? I can't see anything except shows and light and it looks like I am looking through water. The air bubble they placed bounces with my heart beating.   Thanks for everything.
I  can't edit this, I mean shadows and lights, not shows and lights.  I also was only put to sleep long enough for them to put in a nerve block then I woke up. I felt no real pain just a sharpness once in a while around my lower lid.
During general anesthesia the cornea has to be protected from drying. If the surgery is on some other part of the body the anesthesiologist puts lubricating ointment in the eyes and tapes shut. IF surgery is ON the eye during the surgery the assistant tries to keep the cornea constantly 'wet' with balanced saline solution.  I can't tell you which of these mechanisms accounted for your problem:  1 the cornea was inadvertently scratched during surgery  2 the cornea became too dry during the surgery  3 the eye dressing became loose after surgery and the cornea rubbed on the dressing 4 in the office after the patch removed but before the surgeon looked at it you/the staff may have rubbed it.    You will need to be extra careful not to rescratch it for at least 2 months, expecially during sleep. Ask the surgeon about what you can do, especially during sleep to revent "recurrent corneal erosion syndrome"
@iLovePink_77 the air bubble makes for an unusual visual experience doesn’t it? Did you get a wrist band notifying emergency responders/ER personnel to not administer nitrous oxide? The air bubble will diminish in size fairly quickly. I believe you are correct in that saline is used to replace the vitreous immediately after the the surgery.
I went for a follow-up today. I was told that the cornea was probably scratched during the surgery by the clamp that held my eye open.  I was told that the scratch has healed.  I have an eye patch I am to wear for a week after surgery to protect my eye. I have two drops I use 3 times a day.  I was told that the bubble looks like it is on the bottom now but he told me in fact it is on the top that it is how our eyes see. It looks so much like if you're looking at water in a clear glass when you are drinking it.  I cannot sleep in a bed but have to sleep elevated still. The doctor seemed very pleased with how the surgery went. He also thinks the air bubble may be gone at my next follow-up on October 9th. Looking forward to that.  I am also very glad I had this surgery.

Yes, I have a green band on my wrist for any ER personnel should I have to go to the hospital.
Thanks for the follow up comments. Best wishes for the best possible result.  I'm posting again:  You will need to be extra careful not to rescratch it for at least 2 months, expecially during sleep. Ask the surgeon about what you can do, especially during sleep to revent "recurrent corneal erosion syndrome"  Keep the cornea moist with artificial tears, don't blow air on your face it has a drying effect and makes the cornea tissue brittle (e.g. don't run AC or heater in your care in your face, don't sleep under a fan)
I was wondering if I could use artificial tears.  I have retaine® lubricant eye drops that are single-use doses her at my house. I thought last night I would have liked to use something. I have antibiotic and steroid drops but no one mentioned lubricating drops.
Likely the retina surgeon is focusing on  the retina, they tend not to get too engaged on problems  on the retina.  My office for many years was next to a large general hospital and all the patients with post op corneal abrasions I saw and took care of. Retaine is a very good artificial tears but there is no 'best' but many very good ones.  As long as you don't put the tears in for 10 minutes before or after you put in the steroid or antibiotic eye drop is should not be a problem.
What did you see post-vitrectomy?  From my vision, the air bubble is still there but now I have vertical streaks of light across my vision. I am still wearing an eye patch because it drives me insane. It has only been a week today though.
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Avatar universal
You will be under anesthesia for the ERM peel/vitrectomy.
Helpful - 1
Did you have to lay face down and if so how? I am not a stomach sleeper. Are there things I can rent that help me?
I did not, I’m happy to say. Slept propped up with my back against the wall.
The face-down position is more for closing macular holes than post-erm peel
Happy to help. Recall the symptoms that should have you call your retina surgeon immediately,  sudden onset of new floaters especially is small and numerous, flashes of light like lightening or loss of field of vision or change in central vision
Avatar universal
I can’t offer experience with ERM but I did have to undergo victrectomy in both eyes to repair retinal detachment (exactly one year apart.  Followed by immediate cataracts and subsequent surgery for those.  I do have stable ERM in both eyes but no symptoms:  I too was very apprehensive about this surgery.

Trust your dr and never hesitate to call them anytime you have a concern.  They do expect this.

It did take a year for everything to stabilize and happy to say I am at 20/20 both eyes with glasses.

Good luck with your surgery and do post back and let us know how you are doing.   Regards Jim
Helpful - 0
I went for my 2-week follow-up and the surgeon is extremely pleased with the results. He showed me the before and after photos of my eye, before it was puckered and swollen and now smooth.   I still have the goofy black air bubble that has shrunk to the size of a dime. I still am unable to sleep flat till the bubble is totally gone, and therefore, I cannot remove the green band until then.  But will again thank you for your answers. I was so afraid and the surgery was not fun but worth it
Good news indeed. Do you happen to have any asymptomatic ERM diagnosis for the other non-operative eye? I do myself.
So far, so good. I am thrilled with these results. Now I wonder if I will get cataracts. or not.
Almost always yes,  develop at variable rate
Agree with Dr. Hagan, I had a cataract in my operative eye that needed attention 18 months after my ERM surgery. There’s a minor cataract in my other eye as well, but not to the extent of needing removal so I have not had anything done about it.
If I close my good eye the vision is slightly blurry. Mainly in the dead center. I keep wondering is this a scar from the cornea that got scratched or the beginning of a cataract.  The doctor did say that it takes time to heal. I see way better than I did previously though.
that is something I could not answer without looking at the eye. Can't help on this one.
Avatar universal
My retinal specialist used full anesthesia as I recall, which I presume was done in part to avoid any motion by myself during the procedure. My cataract surgeon 18 months after that used a twilight sedation, during which I was semi-aware of the procedure going on and was able to hear him speaking to me. That was over and done with in 15 minutes or less.
Helpful - 0
I was told I wouldn't be completely out but sedated with versade and lots of shots.  I am quite nervous about it.
20931005 tn?1694139995
You both are great! I had a panic attack when they did my laser procedure to tack the tear. It took everything I had not to pass out. If it had been numbed more I might not have had such issues and I am honestly quite embarrassed by it. He kept telling me to look up and it hurt so bad I couldn't handle it. This is another great fear of mine with this surgery. Tell me they will numb me more than just drops that didn't work on me. I would love it if they knocked me out.
Helpful - 0
It will be general anesthesia
I can't tell you how happy I am I asked this here. I just needed some answers because my brain works over time. Thank you so much.
I came here about a week after my intraocular surgery and as you can tell I never really left. Dr. Hagan has been the most valuable asset here by virtue of his experience, knowledge, and no-nonsense approach. Patient experiences rank right at the top as well. If you decide to proceed with the surgery best wishes for a completely satisfactory outcome.
In my clinic this past week I saw 3 patients that were post ERM peel with 20/20 vision,  all of the post ERM's I saw had better vision post op than pre op,  most did not obtain 10/20 distortion free vision but this week 3 out of the maybe 12 I saw did.
I saw the surgeon on Monday and my surgery is scheduled for September 28th. Guess I won't be totally asleep but a twilight,  I won't lie, I am nervous and scared.
You will be under a full anesthetic. Twilight is used for cataract surgery.
Worry and anxiousness are normal.  Best of luck.
Also, I had this procedure done on my LE and if I should ever need to have it done on my RE I would not hesitate to do so. If the surgeon uses gas after the vitrectomy to keep the retina in place while healing that makes your vision in that eye seem unusual while it gradually is absorbed, but otherwise if your outcome is similar to mine your vision will continually improve at what at the time may seem like a slow rate.
With this type of surgery the final visual acuity might not be achieved for up to on year
As Dr. Hagan said, my vision took about nine months to reach its final acuity. Patience will be your friend. Be sure to use the prescribed eye drops as instructed for the first few weeks, which I think were an antibiotic and a steroid. One extra benefit of the vitrectomy is no more floaters in that eye, ever.
I had twilight sedation for my vitrectomy/membrane peel. I was also extremely anxious  but the sedation meds they gave me had me so calm and relaxed that I don't remember most of the procedure.
I thought I would update my post. I kept asking questions because I just knew I felt so awful. Well, come to find out after going to the doctor that on top of the surgery I had, I also have a very low thyroid, and the ultrasound shows I have nodules on my thyroid. Sorry for all my questions in the past. I will see an ENT on December 29th.
There is likely a thyroid forum here on MedHelp.
Both underk-active and especially over-active thyroid can affect the eye.  Hope your thyroid treatment goes well.
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