Cataract surgery and macular pucker

[eyesonyou]

Hi,
I just had cataract surgery on my left eye on Jan. 11.  When I had undergone the evaluation last Fall, my ophthalmologist referred me to a retina specialist to have my macula examined, because he had detected a macular pucker in the left eye.  After seeing the retina specialist, it was determined that I should go ahead and have the cataract removed first.  Then, on Feb. 19, I am going back to see the retina doctor, who will evaluate whether or not an ERM peel is recommended for me.

I had told my retina specialist that I didn't have distortion in my left eye's vision, but last night, I printed off an Amsler grid, and sure enough, I saw some distortion in the lower left quadrant of the grid.

I'm not sure my distance vision is any better in my operated eye, and it hasn't healed properly yet anyway.

When I go back to the retina doc, what are some questions I should be asking him?

I have viewed videos on the Internet of a vitrectomy and ERM peel and it doesn't seem quite as scary as I first thought.
By the way, I had a Crystalens implanted in my left eye, mainly because the retina doc said defractive lenses are difficult to look through if he has to operate.  He actually said my best choices were a Crystalens or a standard monofocal lens, so I rolled the dice and got a Crystalens.  Thank you.

[eyesonyou]

OK Thanks.  I found the article easily using Google Scholar.  It's nice that they included an English translation (which is not always the case).

I will look over this information, and also utilize the link that goes to the Charles symposium.

[JodieJ]

The negative effects of delayed ERM surgery are a personal issue for me, and I'm aware of several articles on the topic.  Try googling "Vitrectomy for epiretinal membranes: Visual outcome and prognostic criteria" for a link to the complete article by L. Geerts et al.  Also try www.vrs-online.com/2007/41.html for notes from a symposium lecture to surgeons by Dr. Steve Charles.  (You can send me a personal message if the link gets censored.)

[eyesonyou]

Hi JodieJ,

I have seen you around a lot, and you have made quite a contribution on this subject!  So thank you.

Would you happen to remember when that recent study was published, who was the author, and in which journal?  I could try and find it on PubMed, but it's always easier if someone already has the citation details.  I used to be a medical librarian!  Searching the literature was not my area of specialization, but I can do an OK job.

I guess there may not be much point in speculation about the macular pucker.  During 2004, I started seeing a wonderful new O. D. , and I remember the vision in the bad eye was only correctable to 20/30.  So in about five years, it went to 20/40.

It could be that the membrane developed in the last year.  I left 18 months between visits to the O. D., and when I realized something was not right, I once again got a new eyeglasses prescription Sept. '09, and a referral to an ophthalmologist.  I am very glad I didn't dawdle when the O.D. handed me the business card for the ophthalmologist.

Oh, incidentally, my retina surgeon is very experienced in the ERM peel procedure.

[JodieJ]

If you do decide to proceed with the ERM peel, I think that you'll be pleasantly surprised to discover how easy the surgery is.  It really isn't scary at all--and mine was totally painless.  However, I do think that it's very important to have a surgeon who is experienced with this procedure.

A recent study shows that the best outcomes in terms of acuity and elimination of distortion are associated with early ERM surgery (i.e., within 10 months of the onset of symptoms).  Delayed surgery may be associated with permanent macular damage.

[eyesonyou]

Well, my eyeglasses prescription (which changed Sept. 2009) corrected my vision in my left eye to 20/40.  Don't know what it is now -- we will find out soon!

[Ray T Oyakawa, MD]

You have the determine the best corrected distance acuity (with glases).

Dr. O.

[eyesonyou]

Thanks.  I have no idea if the distortion is new, because I never tried looking at a grid before the cataract was extracted.
My unaided vision right after cataract surgery was 20/70 in my left eye.  At the two week post-operative check-up, we will see if there is any improvement, but I have a feeling the distance acuity won't be changed much.

[Ray T Oyakawa, MD]

If this distortion is new after the cataract surgery you may havee some CME with the ERM.  It is possible to treat this with drops (Xibrom and Duresol or Pred Forte (non generic)) and an injection of Avastin before an ERM peel.  I usually do not recommend a peel unless there is progression of the ERM,  leakage non responsive to the above treatments, and vision is 20/40 or worse.  This of course depend on your occupation.

Dr. O.