Do I leave the oil capsule in or have the surgeon remove it?

[Bzigzag]

I am a 70 year old female in relatively good health.  I had cataract surgery in January, 2020.  My vision after it, was only slightly improved.  It caused me to have extremely dry eyes.  After several months of trial and error using different drops I got it under control.  When I went for my 2nd post op visit, I was told that I had a film on one eye.  The doctor asked me if I had any blurriness which I didn't.  He told me this was common and that I could have it removed at my convenience  and that it was not serious. Woke up next morning with slight blurriness. Thought to myself, "well there's the film he's talking about."  Since he told me no hurry and do it at my convenience, I waited.   I was busy at the time, and the blurriness was mild so I didn't worry about it till about 5 weeks later when the blurriness got worse.  I called the office to make an appointment to have what I thought was the thickening film lasered off.  I was told I had to see the doc first.  Since the blurriness began worsening I called back to get in asap.  By the next day when I went, I could barely see anything out of my right eye.  Just purple and black.  The doctor examined my eye and to my amazement told me I had a detached retina with 3 macular tears.  I would have never ever waited had he not told me to have the film lasered off at my convenience.  Grrrrr.....Fast forward to next day appointment with retina surgeon.  It was in fact what the cataract doctor said.  Surgery scheduled to repair the retina with the gas bubble next day.  Things went well.  Two months later when I went for a check up I was told that the retina was leaking and had to have a second surgery asap.  So back I went to the hospital next day to have it re attached.  This time with oil capsule.   At present (7 months after second surgery) it's holding with limited blurry vision (22).  The retina surgeon last week gave me the choice to have it removed and take the chance of it re- detaching or leave the oil capsule in and live with the reduced and blurry vision.  The choice is mine.  I wish I had never agreed to a cataract surgery to begin with!!!  Has anyone on here had experience with a decision such as this?  I'm so unsure about what to do.  :(

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

Generally if the retina is going to detach there are symptoms such as increase of floaters, bright flashes of light and possibly loss of peripheral vision. If you had those you should have reported to the cataract surgeons office. But that is water under the bridge.  You have a very serious problem these are my suggestions:
1. Your most important eye is the one that has not had the retinal detachment (RD).  The chance of a RD in your "good eye' are very high, as has as 3-10% depending on what the retina looks like in the good eye, degree of myopia, presence of lattice degeneration. I would be sure you see a retina surgeon every year (in addition to a cataract or general ophthalmologist) and it is a full out emergency if your good eye has sudden onset new floaters, flashes of light or loss of peripheral vision.
2. Even if  the retina surgeon takes the oil out of the back of the eye the chances of that eye having good vision are very small.  You should ask both your cataract surgeon and the retina surgeon "Did I have a macula off retina detachment"  if the macula was off normal/good vision unlikely.  Also ask "What does the macular OCT in my RD eye look like? Is it normal or abnormal, how abnormal:
3. I would strongly suggest you see a DIFFERENT retina surgeon for a second opinion about the oil, and about the prognosis for vision if the oil is removed. ALSO  a careful exam of the good eye and ask about retinal abnormalities and the chance of RD in it.
4. I cannot tell from your post if the good eye has had cataract surgery. If it has NOT had cataract surgery the risk of RD will increase significantly if it has to have surgery. If you have cataract surgery on good eye, you need exam by retina surgeon and clearance for surgery and need to be seen in the post operative period by retina surgeon.

[Bzigzag]

Thank you so very much for your quick response and advise.  I will seek a second opinion as I was considering that as well.  In answer to you question, both eyes had cataract surgery back in January 2020.  When I was first seen for the RD in July, 2020 I was told that it was a total lift.  I will remain as positive as I can but I also do not rely on false hopes.  Thank you again.

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

Best of luck. As a teaching/learning experience, please consider coming back and posting the results of the 2nd opinion.

[Bzigzag]

Thank you and I will do that.    I'll be going to Illinois Retina at Rush University in Chicago, IL.

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

Sounds like a great place to take your problem.

[Bzigzag]

I did seek a second opinion at a university hospital.  He basically said it doesn't matter if I leave the oil in or have it removed.  To answer you questions yes, it was a full lift with 3 tears.  Previous to the detatchment, I had cataract surgery on both eyes.  Since I am near sided and since that is a risk factor for retina detachment, I wouldn't have even had the cataract surgery had I known that since my vision wasn't that bad.  The doctor at the university told me my good eye is 20/40 and the bad eye is 20/400.  I see the retina surgeon this week and I think I'll tell him to just leave the oil cap in.  I was wondering if they do retina transplants.  There are heart, lung and other transplants so why not retina?

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

No they don't do retina transplants. Reason is retina is brain (central nervous system CNS) and that tissue does not regenerate like other tissue. Central tissue behaves differently than peripheral nervous tissue. that is why if a hand is cut off they will try and sew it back on but if the spinal cord is cut they don't try and sew it back together. Of course there is research going on trying to grow new retina using stem cell therapy, nanomole technology, etc.    Ask the retina surgeon if in your good eye you have any areas that would increase risk of RD like lattice, holes in retina.    Don't be too hard on yourself. All surgery has risks even every successful surgery like cataract/IOL.  why is the vision in your 'good eye' only 20/40? Do you have myopic macular degeneration?  When next you see your retina surgeon you need to know for sure why the good eye doesn't not see 10/20.