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Retina detachment after macula hole surgery
I read with great interest Dr. Jones’ article titled "Vitreo-Foveal, -Macular,-Disc,-Retinal Traction" at
http://www.eyes.org/ScriptContent/events/attachments/002-Vitreo%20-%20Macular,%20-Retina%20&%20-Disc%20Traction.pdf
I am a 68 years old relatively healthy male, no diabetes. The only complaints are some hypertension being treated daily with enalapril maleate 30 mg, BPH under control with uroxatral and finasteride and an old acid reflux treated with daily prevacid. I had retinal traction in my left eye first diagnosed in December 2007. It was described (in writing) by the retina specialist (non-surgeon) as "consistent with a stage 1b macular hole and OCT findings consistent with a stage 0 macular hole" and upon my reluctance to submit to surgery, the retinologist agreed to follow the development and checked me every 2 months. I have the succession of OCT's in electronic form, should they be of any interest to a respondent. I saw two other retina specialists, a surgeon and a non-surgeon for second and third opinions and in January of 2009 surgery was recommended as the hole advanced to what was described (verbally) by the surgeon working with the initial non-surgeon retinologist as "a full fledged hole". The surgery was performed on March 30, 2009. I kept 2 weeks of strict face-down position and on May 7, I was told that, as a result of the procedure the macula hole was closed but a retina detachment had occurred with some liquid infiltration under the macula. Since the surgeon who performed the first operating could not operate again until May 11, another surgeon performed corrective surgery on May 8. He installed a scleral buckle and indicated that he sutured 3 pin-holes in the retina which had permitted the vitreous fluid to seep behind it and cause the detachment, drained the fluid behind the macula and applied several points of laser to hold the retina in place. On May 9 at the follow-up visit he declared himself satisfied with the position of the retina and I will see him again on May 13.
At this point I am concerned about the possibility to regain the ability to read with my left eye. An ophthalmologist who is not retina specialist advised me as a friend that in cases like mine attaining a 20/100 vision in my operated eye was the best I could hope for. Since the article I cited also indicates a very high probability of a similar occurrence in my other eye, I was wondering if anyone might be able to help me by:
1. Any newer findings that may help prevent or delay the appearance of a similar ailment in my right eye (could not find a date for the article I cited and I am hoping for the latest insights to be more optimistic).
2. Any guess as to chances of regaining ability to read with my left eye (I understand the extreme limitations caused by a potential respondent not being able to directly consult me)
3. Any suggestions as to what I need to ask my surgeon who will see me this Wednesday May 13.
Reading is a life and livelihood necessity for me and completely losing this ability at some point would have dramatic consequences. Therefore any word of help will be very much appreciated, evidently without any obligation on any respondent’s part.
I am living in Connecticut, within reach of New York and would be willing to see yet another specialist, should anyone consider it to be potentially helpful. I tried to get an appointment in 2008 for an additional opinion with Prof. Stanley Chang at the Columbia University who I understand is the supreme authority in cases like mine but I did not get passed his secretary. Did he write anything about prevention as far as you know?
Many thanks in advance for your kind attention.
http://www.eyes.org/ScriptContent/events/attachments/002-Vitreo%20-%20Macular,%20-Retina%20&%20-Disc%20Traction.pdf
I am a 68 years old relatively healthy male, no diabetes. The only complaints are some hypertension being treated daily with enalapril maleate 30 mg, BPH under control with uroxatral and finasteride and an old acid reflux treated with daily prevacid. I had retinal traction in my left eye first diagnosed in December 2007. It was described (in writing) by the retina specialist (non-surgeon) as "consistent with a stage 1b macular hole and OCT findings consistent with a stage 0 macular hole" and upon my reluctance to submit to surgery, the retinologist agreed to follow the development and checked me every 2 months. I have the succession of OCT's in electronic form, should they be of any interest to a respondent. I saw two other retina specialists, a surgeon and a non-surgeon for second and third opinions and in January of 2009 surgery was recommended as the hole advanced to what was described (verbally) by the surgeon working with the initial non-surgeon retinologist as "a full fledged hole". The surgery was performed on March 30, 2009. I kept 2 weeks of strict face-down position and on May 7, I was told that, as a result of the procedure the macula hole was closed but a retina detachment had occurred with some liquid infiltration under the macula. Since the surgeon who performed the first operating could not operate again until May 11, another surgeon performed corrective surgery on May 8. He installed a scleral buckle and indicated that he sutured 3 pin-holes in the retina which had permitted the vitreous fluid to seep behind it and cause the detachment, drained the fluid behind the macula and applied several points of laser to hold the retina in place. On May 9 at the follow-up visit he declared himself satisfied with the position of the retina and I will see him again on May 13.
At this point I am concerned about the possibility to regain the ability to read with my left eye. An ophthalmologist who is not retina specialist advised me as a friend that in cases like mine attaining a 20/100 vision in my operated eye was the best I could hope for. Since the article I cited also indicates a very high probability of a similar occurrence in my other eye, I was wondering if anyone might be able to help me by:
1. Any newer findings that may help prevent or delay the appearance of a similar ailment in my right eye (could not find a date for the article I cited and I am hoping for the latest insights to be more optimistic).
2. Any guess as to chances of regaining ability to read with my left eye (I understand the extreme limitations caused by a potential respondent not being able to directly consult me)
3. Any suggestions as to what I need to ask my surgeon who will see me this Wednesday May 13.
Reading is a life and livelihood necessity for me and completely losing this ability at some point would have dramatic consequences. Therefore any word of help will be very much appreciated, evidently without any obligation on any respondent’s part.
I am living in Connecticut, within reach of New York and would be willing to see yet another specialist, should anyone consider it to be potentially helpful. I tried to get an appointment in 2008 for an additional opinion with Prof. Stanley Chang at the Columbia University who I understand is the supreme authority in cases like mine but I did not get passed his secretary. Did he write anything about prevention as far as you know?
Many thanks in advance for your kind attention.
Thank you berrywoo. no flashes and the shadow does not seem to be increasing. But early tomorrow morning I will be on the phone to get an appointment with my doctor.
yes, it is possible to have another detachment if there is some unresolved traction on the retina. If there is another detachment the only treatment is surgery. With the gas bubble it will be hard to see much of anything, so it'll be really hard for you to tell if there are retinal problems. Have you been experiencing more flashes, does the darkness/curtain/shadow seem to be increasing, those are the questions you should be asking yourself.
If you feel that there is something wrong then you should definitely go get things checked out. It's better to go and find out that it's nothing than to sit and be paranoid.
If you feel that there is something wrong then you should definitely go get things checked out. It's better to go and find out that it's nothing than to sit and be paranoid.
Today, Monday May 25, 18 days after the second operation for retina detachment on May 7, I am having symptoms similar to those after the first operation: slot above the bubble permits some vision but visual field on the upside is limited and unclear the higher I look, even when I lift my still swollen eye lid. The closer to the bubble limit, which I can see approx. 1/4 from the top, the clearer the view but also vertical lines are distorted in the slot that is opening up.
My surgeon did not respond yesterday, Sunday despite two messages I left and I do not expect a call today either (Memorial Day).
At the last check-up on Wednesday he said that the retina was well attached.
Is it likely to have a second detachment? If so, does it usually require another surgery (the third?) Is it possible that I am imagining things?
A word from someone "in the know"might be helpful while I am waiting for my doctor to call back.
My surgeon did not respond yesterday, Sunday despite two messages I left and I do not expect a call today either (Memorial Day).
At the last check-up on Wednesday he said that the retina was well attached.
Is it likely to have a second detachment? If so, does it usually require another surgery (the third?) Is it possible that I am imagining things?
A word from someone "in the know"might be helpful while I am waiting for my doctor to call back.
1. There isn't anything you can do to prevent a retinal detachment or macular hole.
2. The chances of you recovering reading vision depends on many factors, like how big the hole was and how long it was left untreated. Many people do regain useful vision although it will always be slightly distorted. It's best answered by your surgeon.
2. The chances of you recovering reading vision depends on many factors, like how big the hole was and how long it was left untreated. Many people do regain useful vision although it will always be slightly distorted. It's best answered by your surgeon.
Dear Dr. O.;
Not that you have any obligation to respond but I was wondering whether your lack of comment to my rensponses to your questions were a bad sign or simply you did not have time to fget to it.
Not that you have any obligation to respond but I was wondering whether your lack of comment to my rensponses to your questions were a bad sign or simply you did not have time to fget to it.
Dear Dr. O:
Many thanks for reacting and for your question.
I saw the initial operating surgeon for a follow-up on March 31 after which I spent 2 weeks face-down. After that I saw the doctor again on April 7 or 8 then again on April On April 7 or 8 I don’t believe I could see anything with my left eye. On April 21 the gas bubble had retracted enough for me to see a horizontal line and some shadows above it. I could see a circle when facing down, most likely the perifery of the retracting gas bubble. I remember the doctor asking me to bend over hard and look at my watch very closely. I could tell the time and the doctor said that was a good sign.
He scheduled me again in 2 weeks on Wednesday May 6. I do not remember the exact progress of the returning vision but I am positive that by Thursday April 30, while traveling as a passenger in my wife’s car I was elated that I was able to see through the window cars in front of us. Not very clearly but a lot better than several days before when I was barely able to distinguish the contours of the dashboard. I believe on Saturday May 2nd I started noticing a narrowing of my vision field from top down. I did not give it much attention but by Monday and Tuesday the narrowing was unmistakable and I also started seeing distorted vertical lines in the field. That worried me, particularly since the distortion was on the entire width of the still open field of vision rather than in the central vision as it had been before the surgery. My vision field was still limited on the lower edge by what I think was the edge of the gas bubble, approximately at the equator of my visual field.
On Wednesday May 6, when the doctor diagnosed the detached retina, he asked me I had not called immediately when I noticed the narrowing of my vision field. The reason was that he had never warned me to watch for such narrowing of the vision field and I thought at first that it was a normal variation in the healing process. By Tuesday May 5th when it became rather obvious that the process was not normal, I was already scheduled to see the doctor next day.
Since I wrote my previous post, a kind doctor whose name I found on the internet responded by indicating that although traction is likely in my right eye, a macular hole is not a high probability.
Today I also saw the second surgeon who operated on me May 7. He told me that the macular hole was closed, that the retina was attached, and I understood that I had a good chance to recover sight at a somewhat better level than before the first surgery but a complete recovery was hardly to be hoped for.
I do not know whether this is complete or clear enough for you to form an opinion and give me some input to the first two questions I asked in my initial post. I obviously have to trust my doctor but some recommended additional reading or any further opinion would be very much appreciated.
Yes, I forgot to mention that I am also taking Vytorin 10/10 for cholesterol treatment.
Many thanks for reacting and for your question.
I saw the initial operating surgeon for a follow-up on March 31 after which I spent 2 weeks face-down. After that I saw the doctor again on April 7 or 8 then again on April On April 7 or 8 I don’t believe I could see anything with my left eye. On April 21 the gas bubble had retracted enough for me to see a horizontal line and some shadows above it. I could see a circle when facing down, most likely the perifery of the retracting gas bubble. I remember the doctor asking me to bend over hard and look at my watch very closely. I could tell the time and the doctor said that was a good sign.
He scheduled me again in 2 weeks on Wednesday May 6. I do not remember the exact progress of the returning vision but I am positive that by Thursday April 30, while traveling as a passenger in my wife’s car I was elated that I was able to see through the window cars in front of us. Not very clearly but a lot better than several days before when I was barely able to distinguish the contours of the dashboard. I believe on Saturday May 2nd I started noticing a narrowing of my vision field from top down. I did not give it much attention but by Monday and Tuesday the narrowing was unmistakable and I also started seeing distorted vertical lines in the field. That worried me, particularly since the distortion was on the entire width of the still open field of vision rather than in the central vision as it had been before the surgery. My vision field was still limited on the lower edge by what I think was the edge of the gas bubble, approximately at the equator of my visual field.
On Wednesday May 6, when the doctor diagnosed the detached retina, he asked me I had not called immediately when I noticed the narrowing of my vision field. The reason was that he had never warned me to watch for such narrowing of the vision field and I thought at first that it was a normal variation in the healing process. By Tuesday May 5th when it became rather obvious that the process was not normal, I was already scheduled to see the doctor next day.
Since I wrote my previous post, a kind doctor whose name I found on the internet responded by indicating that although traction is likely in my right eye, a macular hole is not a high probability.
Today I also saw the second surgeon who operated on me May 7. He told me that the macular hole was closed, that the retina was attached, and I understood that I had a good chance to recover sight at a somewhat better level than before the first surgery but a complete recovery was hardly to be hoped for.
I do not know whether this is complete or clear enough for you to form an opinion and give me some input to the first two questions I asked in my initial post. I obviously have to trust my doctor but some recommended additional reading or any further opinion would be very much appreciated.
Yes, I forgot to mention that I am also taking Vytorin 10/10 for cholesterol treatment.
MEDICAL PROFESSIONAL
When were you seen after your March 30th surgery? Retina detachment is something retinal surgeon watch for after a vitectomy for macular hole.
How vision did you recover before your detachment??
Dr. O.
How vision did you recover before your detachment??
Dr. O.
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