Macular edema with cysts in foveal pit - when not to do membrane peel?

[DesperateRetina]

Hi,

Is there someone who can provide feedback and/or point me to some study results on the following.

For people with macular edema from epimacular membrane resulting from retinal tears and detachment ...what is the likelihood of the following (suggested 3 point scale of highly unlikely, 50:50, and highly likely):

      ▪ Spontaneous resolution of the macular edema and associated cysts -
      ▪ Resolution of the macular edema using some medical approach without removal of the membrane -
      ▪ Resolution of the macular edema after vitrectomy and membrane peel -
      ▪ Failure to resolve macular edema -
      ▪ Other scenario - please describe and provide likelihood -

If an epimacular membrane is causing traction and is not removed, does the presence of macular edema with cystoid spaces in the foveal pit (on OCT) always result in progressive degradation of vision with time?  Most times, 50:50, or rarely?

If you were an eye surgeon and it was your eye - would you spare a relatively clear crystalline lens and ignore a symptomatic epimacular membrane with macular thickening and cystoid edema?

OR alternatively, despite a pretty good natural lens would you be more concerned about getting rid of the membrane and the cystoid edema?

If the membrane and edema are permitted to remain, is it likely that there will be permanent damage to the fovea over time - so that removing the membrane in 5 years or even in 20 years when cataract surgery is needed due to aging will leave the patient with very disappointing vision acuity and quality?

Thank you for your insights and feedback.

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

Don't think its possible to handicap each of those scenarios for a variety of reasons usually that these cases are so unique and complicated that they defy standardization like that which can be done with cataract/IOL surgery. Your best bet would be to pose those questions to your retina surgeon who is in the best position to answer.

[teller4]

For Desperate Retina, Your case does sound complicated and hopefully your retina specialist has been able to address your concerns and questions with a plan.  

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

=