epiretinal membrane peel & vitrectomy

[naoye]

I'd very much appreciate any advice in deciding whether to have this surgery.  I'm very myopic but, with contact lenses, my eyes are:  L 20/20 and R 20/70.  The epiretinal membrane has been present in both eyes for a few years.  Tests a few months ago showed that it had progressed.  (I've recently developed pingueculae as well.)  The surgery is recommended for my non-dominant R eye.  I haven't been able to read well with this eye for several years because of some corneal warping from HSV and a large floater.  Now, with the membrane, I'm having difficulty reading with both eyes, as well as having to be extra-careful driving, etc.  The surgery will remove the floater and likely improve my R eye to about 20/40.  The major  risks seem to be cataract formation, recurrence of the HSV, retinal detachment and infection.  

What I'm mostly wondering about are more minor risks of the surgery, especially possible side effects that might make it difficult to wear contact lenses (such as drier eyes?) because my vision is poor with glasses.  It would be quite devastating to gain 20/40 vision in my R eye but be unable to wear contact lenses.  I was particularly interested in the comments by JodyJ on this site about "bothersome problems" following this kind of surgery (even with vision improvement to 20/20) and wondered whether Jody would mind elaborating a bit on this - even though everyone likely has a different experience.  If the membrane progresses further, I won't have a choice about the surgery.  But I'm hoping this will not be the case.

[naoye]

PVD stands for posterior vitreous detachment which I understand occurs quite commonly as we get older.   (When I had cataract surgery, I was told that I have it in both eyes.  There is another  post about PVD, more recent than yours, with a reply from Dr. Hagen.)  I don't know what the number would mean though.

I hope one of the forum doctors or Jodie will respond more fully to your questions.  Perhaps you could try repeating them in a separate post (this string is pretty long now!) or repeat them on the Expert Eye Care Forum on this site.

[hungan]

Thank you JodieJ & Naoye for sharing your experiences and knowledge. I find them very helpful.

My L eye ERM peel was originally set for May 8, but due to a backup system malfunction they re-scheduled it the following May 15.

Towards the end of that day I started seeing a large long arcing floater that looked like a worm with a large head in my R eye on the upper part of my vision. Then, momentarily I saw light flashes in the lower part of my vision. It never repeated after that. The floater remained to this day, but know it is more translucent and less annoying.

When I called my clinic the next morning to report what has transpired, they dispatched me to see another surgeon right away. He explained to me that they want to rule out anything serious. That is when I overheard him telling the nurse I have a PVD of 0.3 in both eyes. Does anyone know what this means?

Does anyone know if there is a correlation between deviated septums and ERM? It so happens that I have a left nostril deviated septum. When I blow my nose, most of the force is imparted in the left nostril. The L eye happens to be the one with the worst ERM.

Thanks again for your replies.

[hungan]

For my post operative care after ERM peel, I am or have taken the following:

I am just finishing the last eye drops of Maxitrol eye drops which is a combination of antibiotics & corticosteroid. I have to take this until the last eye drop is gone.

For the first week, I applied one eye drop of Atropine Sulfate Ophthalmic Suspension in the L eye at bedtime.  

Soon after I finished off the Maxitrol, I will start the prescribed dosages of Prednisone Acetate Ophthalmic suspension - 4X daily the 1st wk, 3X daily the 2nd, 2X daily the 3rd, and finally 1X daily on the 4th week.

My question is about the Maxitrol & Prednisone containing corticosteroids. Should I be concerned about the risk of  glaucoma, damage to the optic nerve, and cataract formation? I know there is a rhyme & reason for prescribing these medicine after eye surgery, and the dosage are prescribed as such  to minimize risks.

BTW, I am beginning to see better through my L eye without corrective lenses, albeit the visual distortions are grossly evident. With the corrective lenses, it is much worst. This is viewing the computer screen about twelve to eighteen inches away. One the Amsler Grid (white lines, black background - http://www.opt.indiana.edu/riley/HomePage/Amsler_Grid/4TEXTamsler_grid.html) test, the vertical lines are grossly distorted although better than last week. The problem I have is that when I cover the R eye, the horizontal line become very faded/blurry almost disappearing.

Is this normal in the course of healing? Sharing your experiences/comments will be greatly appreciated.

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

You may be able to get a full text copy by calling "your" hospital medical library and telling them you have been a patient of their's and would they obtain a copy for you. Some hospitals will do that.

Or you can call my office tomorrow. the phone number is listed under my profile in "the Doctors" section and leave either a fax # or an e mail address and I'll send you the full article.

Thanks again for all the time and expertise you lend this forum

JCH MD

[JodieJ]

Thanks for the citation, Dr. Hagan.  A few of the very best vitreoretinal surgeons will operate today on patients with 20/20 acuity but significant metamorphopsia.  I wish I had access to entire article; I'd love to know the authors' definition of "successful" ERM surgery.  (How successful could it be if it failed to augment quality of life in a meaningful way?)  

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

Study: Clinicians should pay more attention to metamorphopsia in patients with epiretinal membrane
Using the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), researchers prospectively evaluated the vision-related quality of life in 28 patients both before and three months after undergoing vitrectomy for epiretinal membrane. Surgery significantly improved the mean NEI VFQ-25 composite score from 66.2 to 77.9 postoperatively. But even after successful surgery, quality of life remained at a lower level compared with normal controls. American Journal of Ophthalmology, May 2009