Macular Pucker surgery updates

[Jen61701]

I have been diagnosed with a macular pucker. there is a deinitive membrane over the retina revealed by an OCT scan. I am 46 and has 20/40 vision in the affected left eye and 20/25 in my good right eye.  Other than tired eyes from using my eyes for close-up work, I am not obvious of the distortion in my left eye vision.  My question is have there been changes in macular peeling or other treatments to justify the risks of cataracts at this time?  

A retina specialist diagnosed me this past Aug 23. He indicated that surgery is an option.  When I asked re: when, he says, within a year.  He may have been prompted to say that because I indicated that I was frustrated. Obviously I have no frame of reference on what's involved.  

Now that I have time to do reflect on the pros to have the surgery and the risks of cataracts, I wonder if there have been advances that cut down on the risks. I 'd now recall the bruising htat the left eye got in Oct 06 when a heavy door was pushed into  my face as I were entering a conference room while someone was leaving.  the bruising went away after a few days, with no apparent changes in vision. So this may not be an idiopathic case.

Apprecaite your thougths.  Thanks.  Jen

[perky366]

A related discussion, bacterial eye infection was started.

[Jen61701]

Thank you - I was away on vacation. good break from this. I am back and ready to tackle this. I will have questions.  Thanks. Jen

[JodieJ]

It looks like this site blocked the email address you posted.  This didn't used to happen here, and it was very helpful to have the option of communicating with others offline.

Dr. Packo has an office in Harvey, Illinois (a Far South Side suburb).  It's probably only about 2 hours away from you, and you could avoid all the city traffic.  He's reputed to be a top retinal surgeon, and he impressed me as being quite personable.  I don't think he'd recommend surgery for you unless he felt that you were a good candidate, so he'd be a great source for a second opinion.  His office number is 708-596-8710.  It might be a good idea to prepare a list of questions and concerns in advance.

I'd be happy to answer any specific questions that you have.

Jodie

  

[Jen61701]

Thanks!

My email is: ***@****.  Looking forward to hearing from you, Jen

[JodieJ]

I really don't think that your involvement in clinical trials would be at all helpful.  You do need to monitor your condition, because in a minority of cases an ERM can worsen over time.  (Usually it remains stable after a few months.)  As far as I know, vitamins and diet won't help (or hurt).  There's a lot of information available online about ERMs and the surgery to peel them.

My surgeon was Dr. William Mieler at the University of Chicago, who is reputed to be among the best retinal surgeons in the US.  (Because the U. of C. is a teaching hospital, you should request that none of the fellows or residents participate in your surgery.)  I also consulted Dr. Kirk Packo, a top retinal specialist in private practice, who is affiliated with Rush-St. Luke's.  I think that he'd be an excellent choice, and it was surprisingly easy for me to get an appointment with him.  IMO,  it would be worth the 3-hour drive to have the surgery done in Chicago.  Although it is a painless outpatient procedure taking 45 minutes or less, it is MAJOR surgery.

There's more information that I'd like to share with you, but I don't think that this forum is the right place to do it.  If you get a free email address at yahoo or hotmail and post it here, I'd be happy to communicate with you off-line.

Jodie

[Jen61701]

Thank you both for your responses.  I am clear that I need to have a more in-depth discussion with my retina specialist. He is highly regarded by his peers and his patients.  I believe that his surgical option was in response to my highly agitated state I were in when I first learn of this.  What I will be following an 'eye-healthy' diet, staying healthy, and monitoring my condition.  I'll be following clinical trials and get involved if I can.  

Jodie - if this board allows for it, and you are open to sharing the info, who did you treat with in Chicago. I am 3 hrs downstate from Chicago.  Thanks again - Jen

[JodieJ]

A couple of years ago, I was in a position very similar to yours.  My vision in my affected eye was 20/40 due to the ERM, and my other eye was 20/20.  My surgeon suspected that my ERM was the result of a trauma but couldn't say for sure, and essentially it didn't make any difference.  There is new "sutureless" vitrectomy equipment available which greatly improves post-surgery comfort and speeds recovery.  Most retinal surgeons in my area (Chicago) will operate on an eye with 20/40 vision if the ERM is bothersome.

I decided to have the surgery with one of the best retinal surgeons in my area.  My outcome has been somewhat mixed.  My vision in the affected eye is now (post-cataract surgery) 20/20.  However, I have have some bothersome problems with that eye that I didn't have pre-surgery.  All things considered, I'm probably better off now (but not certainly better off.)

If you do decide to have the surgery (which is not at all painful), please make sure that your surgeon is the VERY best in your area,  someone who has done of lot of this particular procedure.  You will almost certainly develop a cataract due to the lens' exposure to oxygen, but this is not necessarily a bad thing.  I was a high myope for most of my life, and I'm pleased as could be with the results of my cataract surgery with an aspheric monofocal implant.  (I did a clear lens exchange in my other eye, with equally good results.)  Please don't even consider a multifocal IOL--it's much too risky with a slightly damaged retina.

A vitrectomy with ERM peeling is not emergency surgery.  Before you make a decision, I'd strongly suggest that you do a lot of research about the procedure.  Best wishes.

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

Hello Jen,  no way to determine if you epiretinal membrane (ERM) and pucker is due to the trauma. Many to most are "idiopathic" (physician talk for "we really don't know for sure".

Most of the retina surgeons in our group would probably NOT operate on a 20/40 eye as the risk/benefit ratio is not favorable.  If the vision was 20/100 and creating a big problem and you already had cataracts it would be a different story.

JCH III MD Eye Physician & Surgeon