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Now need Laser Posterior Capsulotomy After Cataract Surgery & 2 RD'S, what next?

So after seeing my eye doctor, It was scheduled for me by the eye doctors office to schedule with my cataract surgeon for further evaluation on eye issues.  My eye sight in my left eye was worsening after only a few months since my last visit plus,  I have also been experiencing a great amount of glare in bright lights and the sun which continue to be hard to bear.  The eye doctor said I have swelling in both eyes, some scarring, and The left eye has some bleeding.  I had cataract surgery in March of 2014.  I had retinal detachments in July and October of 2013.  

My cataract surgeon suggested I schedule for a YAG Laser Posterior Capsulotomy, which is quick and will clear up the distortion and glare, one eye at a time.  I am not thrilled about having another surgery obviously, but feel confident in the doctors I am seeing for this, yet am concerned just the same!

Any surgery has risks, obviously...!  Further RD'S?  Is the surgery making that more possible, or if I don't do this procedure would my eyes continue to have increased glare and scarring and loss of vision?  

I have to admit that my concerns come from having one thing after the next, and possibly causing more future issues because of another intervention or surgery of sorts?  How much can the eye take, and at what point is more surgery making it worse, or not worth the added risks?
What is the recovery time from this procedure?  At what point, if I go ahead with this surgery as scheduled, do I know that this has been successful?

Thank you for any insight you may have
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Avatar universal
Dear Pinhole & any others who are in need of Laser surgeries to correct vision problems or to deal with complications related to having encountered problems with your vision and/or other procedures related to your eyes... I have had Cataract surgery & Retinal Detachments on both eyes, and a YAG on my left eye.  I am now scheduled for pars plana vitrectomy as I was diagnosed with epiretinal membrane.  So, I am having an epi retinal peel /ERM in one week in hopes of clearing up the scar tissue so as to no longer have the blurry and reduced vision.

It is mostly my central vision in this eye/which had the YAG procedure, as well, that is most affected right now.

Trying to stay positive, and waiting out the days until then!
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Avatar universal
Hi,

It does seem like your situation has been explored very thoroughly and that you have gotten a good explanation for the necessity of the surgery.  

I didn't seek a second opinion for the membrane peel that I had several years ago. I found the recovery to be much easier than for the RD repair. I had a gas bubble, but the face-down positioning did not last as long, plus I could see really well the very next morning since an IOL was implanted at the same time.

If you do a search on ERM peels on this site, as I recall there is some discussion suggesting that if the procedure is deemed necessary, then it is better to do it sooner rather than later, which seems consistent with the advice you've received.

I wish we weren't having these complications!

I hope you are feeling some relief now that a date has been set and a plan has been made.

I'll try sending you a PM as a test. Could be that the feature has been shut down on this forum, just as there are no longer ophthalmologists answering questions on this site as of last summer.

Meanwhile, positive thoughts!
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Avatar universal
Hi, I spoke with my ophthalmologist and she feels it all sounds correct and it's the appropriate course of action after reading and seeng all th info.

I think I am going to stick with it.

I tried sending a message just to you, but after several tries am unable to enter the series of letters for the security code!?!  Is it my eyes, and am I seeing those letters correctly?  You would think on an eye message it would be easier!  

Oh us poor vision challenged people!
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Avatar universal
I have scheduled the surgery for the peal, but am mulling over another opinion!  I so appreciate your comments, as it has confirmed that I really should consider another opinion....assuming I can find the right person to get checked by!   My ophthalmologist feels comfortable with the diagnosis and course of action, along with finds what has happened with me to make sense...but I intend to check back with her, as I still feel as if a recommendation for another opinion could be prudent.  It seems it is the fact they can't get the swelling under control in the left eye, and that the central vision could be damaged without intervention shortly...  I am scheduled for the 28th.
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Avatar universal
A postscript ... a vitrectomy has not been ruled out in my case. It's a matter of wait and see for now whether it will be necessary.

As always, best wishes to you!
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Avatar universal
Hello Greenbaypat:

At my 8-week followup my scan showed additional improvement such that now I will be tapering off the prednisolone, reducing more each week, but keeping on with the nsaid drops at the present rate of 4x per day. Hopefully the swelling will not flare up again. When it was diagnosed, it was severe -- I had cysts/bubbles that have since flattened out.

I asked about traction and was told there was some but that it's off to the side and therefore not a problem. I also have a "mild" membrane.

So the plan is to continue this conservative course, and to see what the situation is 8 weeks from now.

For me, it would be important to get a second opinion before undergoing a significant surgery.

If you have specific questions please feel free to send me a pm.



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Avatar universal
I had my first followup 3 weeks after starting the drugs. My next appointment will mark 5 weeks later (conclusion of 8 weeks on the drops). The first surgeon I saw scheduled me for a vitrectomy. It's the second-opinion surgeon who recommended drops to start. He also mentioned an injection.

You'll find lots of info from other patients about epiretinal membrane peels/macular pucker using the search function on this forum.
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Avatar universal
Thank you for your clarification on your progression, as yes, I hadn't understood it to be that way!  I am happy to learn the correct progression as that does give me hope for similar results!!!

I did just post a question on macular pucker and cataract forum, as it appears another member may be considering this same procedure as we have been discussing here!  

I just spoke with my cataract surgeon, and he felt the surgery, based on my retinal surgeons summary from my visit is the best course for me at this time.

I am still unsure, and have more questions.  Plus, I feel I lack clarity on a few issues and the terminology used!?!

I also hope to speak to my eye doctor.

I will post more as I get through some of those calls...

I am curious in that you too are doing the drops with some improvement, and at what point do you or they say-enough drops...now surgery?  Mine, two weeks?
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Avatar universal
Thank you for posting the update.

I am glad your pressures are good!

Your surgeon gave you a lot to think about. Are you inclined to get a second opinion? It might be useful.

I suspect I am in the same boat. My eye does not seem to be making further gains despite continuing the drops. I will let you know what happens at my appointment next week. I think you've given me a preview.

I did have a second vitrectomy on my other eye to peel the membrane that had developed. It was done at the same time as the IOL/cataract surgery, nine months after the vit-buckle RD repair, and I got a good result. What I don't know but am curious about now is whether there was swelling before that surgery. All I knew was that my vision had decreased to the point that surgery was advised.

Take good care. I will be thinking positive thoughts for you as you figure out the best course to take. Please continue to post.



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Avatar universal
So, my Eye appointment with the retinal surgeon said my left eye is still not healing well enough from the drop regime, while the right seems to be.  
My IOP readings were lower with all of the drops anyhow.  
15 left 18 right
My vision is still decreased in the left eye, and some in the right.
He said I had 3 options

1.) He suggested I consider the vitrectomy surgery again to remove the scar tissue which would help alleviate the swelling and improve my vision (possibly).  

2.) I could have the steroid injection, or the (Shot in the eye.). The shot could lead to or a fix or may add risk of glaucoma .

3.) is to do nothing, just continue the drops, which he feels is not sufficient.  I asked if I did this what would the result for me be?  He said -if I left it that I could have worse vision possible or stay as is, or ?

His recommendation is to have Surgery within a month and schedule ASAP.
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Avatar universal
I am so sorry! I see I have created confusion here.

The YAG didn't cause all those problems. My intention was to provide the history of the eye that I ultimately had the YAG in. Since the YAG I have been dealing with edema. (There may have been some edema even before the YAG.)

I really hope I have not caused you to worry.
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Avatar universal
Are you saying, by implication by the doctor that he would have said Glaucoma?  Or what?  

Answering that though, no, rarely does he say or make predictions of what's next.

So, I find the details and results of your YAG to be extremely alarming!  Gosh, all I have read about YAG states so strongly about the safety....minimizes side affects and extra procedures?!!
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Avatar universal
Hi Greenbaypat:

Did the doctor not mention the implications of the hemorrhage? That word was mentioned in my last visit too, though it wasn't discussed, just noted. Now I am really wondering!

The sequence of the events in my YAG eye was (1) sudden onset of flashes and floaters, with tears noted and heavy lasering done to prevent detachment  (2) few weeks later a dense vitreous hemorrhage blocked my vision (3) several weeks later detachment then vit/buckle repair.

(At that time the hemorrhage was caused by retinal blood vessels bleeding into the vitreous.)

The drops have been helping, but a line of text is still somewhat distorted.

I hope your news will be good at your next appt.!



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Avatar universal
Hi Flossy and pinhole also!

So, I felt after posting the issue of the optic nerve issue that I should post that as a question, as I can't seem to locate much information to answer my concerns on it.  It is titled Hemorrhage on optic nerve.  I will post my results of my appointment next week here of course.  

Both of your support and ongoing positive thoughts have been very helpful!  Thank you!
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Avatar universal
So, I believe I forgot to say that the cataract surgeon also said I have a small hemorrhage on the optic nerve now, as well.
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Avatar universal
Thank you for the reply. But, Yes-I am so Lucky to have a Great Team of doctors!  And they are  Working together!!!  My doctor is an Optometrist, and I feel she is and wants the Best!  Who can ask for more?  Surgery, well not sure what the cataract doctor was implying or attempting to prepare me for with that comment.  But, feel it has to do with the traction issue.

The way I understand "Vitreomacular Traction Syndrome" is what I feel I am experiencing currently in my left eye.  My macula, the center part of my vision, is not clear.  The vitreous is or has pulled away, and may be pulling or sticking to it.  With the pulling or swelling, the surface of my macula distorts my vision with it.

The OCT test and a dye test will probably be done at my next appointment -a little more than a week by the retinal surgeon.  Surgery may or may not be suggested.

In the meantime, I am hoping, praying, doing drops,...and reading about some options and or alternatives that could be of assistance.

I see some similarity of your needing a possible vitrectomy for macular membrane, with the macular hole, the swelling, and central vision fuzziness that I am experiencing-equalling central vision issues...  This is all confusing to me.  I have seen some suggestions for increasing certain vitamins like C and E, along with herbs and natural treatments(or potentially helpful agents) for eye issues.  Often the medical industry is not in support of them, as the research isn't present, and so on.  I get that too, but still am willing to research them in the event something may be of safe benefit or improvement.  Besides C and E, I see Bilberry and Ginkgo biloba mentioned quite frequently.

Interestingly Bilberry, has been approved in Germany for treating diarrhea and inflammation of the mouth and throat.  So, a potential connection of this berry, though not recognized here-may assist swelling....   I don't know, nor do I attest to quackery type of medicine or treatments...but a fruit-with potential?

In Madison Wisconsin, "David Kiefer, MD, a research fellow in the department of family medicine at the University of Wisconsin in Madison, says it makes sense that bilberries have a reputation for helping conditions ranging from retinopathy (abnormal or damaged blood vessels in the retina) to diarrhea to heart disease.

"A lot of these [conditions] have an inflammatory component, so some herbs treat a variety of things," he says. "There's oxidative damage in so many illnesses. Whether in eye vessels or leg vessels, we can get a positive effect."

Kiefer says patients with macular degeneration -- the deterioration of the central part of the retina that can eventually cause blindness -- have reported that they use bilberry extract, with mild benefit, "but it's hard to sort out the anecdotal report from the placebo effect.''"

Cautions on anything of course, but Bilberry mainly on Warfarin seemed to be the main issue with it.

I only wish it was Blueberry, or Raspberries, as I love both of those and would love the excuse of having to purchase and eat those daily!
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Avatar universal
That's wonderful how well coordinated your care is! Collaboration at its best. It the doctor whom you ran into and who explained things so well an optometrist?

Sounds as if for now you and I just need to keep on using our drops (remember to shake the Presnisolone!) and be patient as we wait for the next appointment unless we notice a change.

I am puzzled by the comment about surgery, too. Is surgery ever used to fix edema? I may be in for a vitrectomy for macular membrane removal at some point, if it progresses.

Happy Spring to you, too!

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Avatar universal
So I saw my  cataract surgeon again just one week after my last visit with him.  My pressures are lower than last time, with the use of the drops.  IOP 20 L 21R.  He said with my pressure adjusted, it is more like 17.

They did do the eye scan like you asked.  It seems that they felt things were at least constant since my last visit, with improvement shown in the lowering of pressure.

I am scheduled to return to the cataract surgeon in 6 weeks.

My Appointment  is coming up in two weeks with my retinal surgeon.  The cataract surgeon said that the retinal surgeon may want to do surgery to fix my left eye, but he said I probably wouldn't.  (I am not sure what he meant by this comment!?!)  I did ask him if he thought I should get in earlier to the retinal clinic and he said no, there isn't an emergency or anything.  He said that  When my left eye settles down we can do the YAG on the right eye. ...SO...  See him again in 6 weeks & keep on the drops. My Vision was measured at 20/60 in left.  (Was 20/50 (I believe) a week earlier.

Coincidently, I ran into my eye doctor who then proceeded to question me on my appointments....this WAS Very interesting-not to mention helpful!....the short version of this great discussion, is better clarification of the situation, at least for a week ago anyhow...and she is working on getting a better understanding of my most recent visit and tests that were done.  I expect I will hear from her, and or one of the other two doctors if needed, or if something else should be looked at closer sooner, &/or at my two week appointment.  It is reassuring to have her professional intervention and advice as this progresses.  With the 3 of them, it seems like I have somewhat of a second opinion available to me.   While the specialization seems extreme or unusual to some, for me it has become an amazing team of professionals acting more like a brain storming trio trying to figure out what's going on and what my best next step is.

Of course, my hope is that this just heals on its own, or with little or no extra invasive procedure to be required!....  I don't feel this will be the case, as the traction in the left eye has been brought up again...but I am hoping, doing the drops, and trying to stay positive and busy!

Happy Spring!
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Avatar universal
See my in text reply to your last message...
The main question: Did you catch any fish the other day?

Yes!  It was Fun!   It appears this will be the end of ice fishing for this season, but who isn't ready for Spring?

I am glad you have gotten relief from the discomfort! My eye feels better too.

Yeah!  I still feel some discomfort in my left, but it's still better than it was, so that is good!

I have never heard that flying or altitude poses a problem unless one has a gas bubble in the eye.

The Gas is a problem, for sure!  I have been doing some research on the extra pressure associated with flying and altitude changes on IOP, and find little concrete evidence.  However, I also wonder if it is something that is a bit harder to track or locate an adequate amount of test subjects for, as the population with eye issues as some of us have are in a smaller group...and therefore there may not be much research or tracking of these multiple issues, in coordination with the extra pressure changes with altitude and pressure from it and flying.  Do you know what I am saying?  I am not trying to be over thinking this, yet wonder about extra pressure in cases like ours being out of the norm and possibly at more risk.
Some of what I did find that threw some caution in were most often found with glaucoma patients...
A Study with this link here:
http://www.iovs.org/content/48/4/1622.long

The quote below is one  I  took from a study which I found the correlation, well,  .inconclusive, at best, but when taking  into account the thickness of the cornea, and the other issues associated with our challenged and weaker eyes....?

"IOP measurement can be complicated by anatomic, instrumental, and physiological sources of error. The effect of altitude on IOP and its significance may be masked by several factors. Failure to correct for corneal thickness (which increases significantly at altitude ) can artificially inflate IOP readings. Furthermore, it is difficult to generalize from studies with a small number of subjects, measured in difficult circumstances by different methods, with the added...."
IOP air travel-Glaucoma
http://www.glaucoma.org/treatment/summertime-tips.php

Currently I am seeing only the retina dr. At each visit I have a scan done of both eyes.  After I'd been taking the drops for several weeks, a repeat scan showed the significant improvement (flatter retina and resolution of some of the cysts) I mentioned earlier. I saw the scan myself.  I was first checked at three weeks. The next check will be five weeks after that.

Good news that improvement is being shown for your eyes!  That is encouraging and great to hear!  Longer times between visits is a positive as well!

At the retina office my pressures are measured with a penlike instrument (a tonometer?) "bounced" gently against my eye.
My RDs were three years apart--like you, one in each eye.

I have had the same instrument used for pressure checks too.

I was given a prescription for glasses one week after my cataract surgery this last time. I wonder whether that was too soon, whether the refraction might differ by now. Do you wear glasses, and if so, how soon did you get a new script after your cataract surgeries? My lenses are no-line progressives.

One week!  Wow, that was quick!  I did choose glasses as well, as I just wanted something over my eyes.  I really didn't need them for distance originally, as my eyes were hovering at 20-20 or nearly that!  Recently, that has changed...but also the on and off for reading, just made getting glasses easier... So, glasses!  My eye doctor said I could wear contacts, but as the other issues have presented themselves now...all on hold!

The trend toward larger frames seems like it would be helpful to us.

Yes, all this is scary to me, too. Staying busy helps.
Scary, so true!  

I will give a summary of this last visit shortly
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Avatar universal
The main question: Did you catch any fish the other day?

I am glad you have gotten relief from the discomfort! My eye feels better too.

I have never heard that flying or altitude poses a problem unless one has a gas bubble in the eye.

Currently I am seeing only the retina dr. At each visit I have a scan done of both eyes.  After I'd been taking the drops for several weeks, a repeat scan showed the significant improvement (flatter retina and resolution of some of the cysts) I mentioned earlier. I saw the scan myself.  I was first checked at three weeks. The next check will be five weeks after that.

At the retina office my pressures are measured with a penlike instrument (a tonometer?) "bounced" gently against my eye.

My RDs were three years apart--like you, one in each eye.

I was given a prescription for glasses one week after my cataract surgery this last time. I wonder whether that was too soon, whether the refraction might differ by now. Do you wear glasses, and if so, how soon did you get a new script after your cataract surgeries? My lenses are no-line progressives.

The trend toward larger frames seems like it would be helpful to us.

Yes, all this is scary to me, too. Staying busy helps.


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Avatar universal
Eye pressure link
https://www.glaucomafoundation.org/info_new.php?id=156&cat=12#28

Also if I didn't say this before, or this isn't an obvious situation, based on my eye correction and issues, but I have been told I have thinner corneas than normal.  

A link I was just reading, references this
http://www.allaboutvision.com/conditions/hypertension.htm
Info about - Elevated eye pressure monitoring, and glaucoma ,

Thanks for all of your input!  You and Flossy have been great!  

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Avatar universal
In regards to the visual field test, I actually was told that I lost some vision in my left eye after my RD.  My eye doctor said I couldn't drive a school bus.  I do notice I miss something approaching on the left, but not sure why this didn't show up!?

I just bought another pair of over the top glasses, the brightness drives me crazy!  Even indoors, when it is SO bright, and someone is standing in the light, I can hardly see who it is or features clearly.

I have the same featureless in plant as you without features as well!  I believe both are the same, but only have one card in my wallet now to check.  I think the other is left in a case at our cottage, so will check that eventually!

I agree that describing the discomfort is awkward, but concerning and noteworthy, just the same!?  I do feel dryness can be part of it, even though I feel I am drowning in drops!  Two days, and it may learn more, but feel the eye, "pain or discomfort," is somewhat better anyhow!  But, I will bring it up and discuss this current and previous concern.

Retina scans, not each time, but the cataract surgeon usually does this one.  I will ask for the retina scan if not, the health of the retina is very important, & I have already had RD  in each eye in 2013, cataracts in 14, and one YAG in 15 with one more tentatively scheduled in the near future,...but only after months of stable eye healing...without swelling, and some of the current issues being treated for.

It is frustrating that the steroids raise the pressures in the eye, but know that is how they work.  I just don't want to have this lead to glaucoma, nerve damage, another RD, the shots, or anything else!?!   I am starting to wonder if this will never get balanced out without incurring more damage, or ability to not have to worry that something will happen or need to be continually monitored with ever changing treatment methods!

How often are you being checked with your drop regime, and which doctor do you see for this?  What tests do they run?  How is the eye pressure measured at your visit?  Do they use a different pressure measuring tool at your various eye doctors?

Also with the pressure issues in the eyes, I have concerns over how altitude or flying affects this.  Are you familiar with this?
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Avatar universal
You said," "In terms of the pain in your eyes, if you had a chance to mention it on Thursday at least the dr knows about it and can give you some advice.  That's something for which I don't have an idea about what could cause it, although it certainly sounds unpleasant. ".

Not exactly Pain, but discomfort for sure.  I had thought it was gone, but it still exists-just lessened now.   I do hope the improvement continues, as it is troubling.  

In response to the traction reference that the cataract surgeon threw out on my last visit you said, "In terms of the 'traction problem', I've seen that term used when describing the vitreous of the eye pulling on the surface of the retina.  As people age and the vitreous jelly inside the eye becomes more fluid-like and shrinks a bit, sometimes it tugs on the surface of the retina.  From what I've read it sounds like many patients have the vitreous separate from the retina without any problems, except that sometimes it gives transient 'flashing' or 'barber pole' visual illusions.  For some other patients the tugging or traction is stronger and can lead to a surface problem on the retina like a tear or layer separation in a small area of the retina.  The retina specialist can order an OCT to get a 'side view' of the retina layers, if such a thing is suspected."

  Thanks for the info and potential insight!  It is reassuring to go in with some background info.  It is increasingly frustrating, and not to mention scary each time a new issue is brought up.  

I appreciate everyone's input, as it is all quite scary and overwhelming, at times.

Thank you!
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Avatar universal
Thanks for the reply, I will let you know on the brand and check out the model number-fascinating you have two different!  I am going ice fishing, so will reply and update shortly!  Happy to say though, the pain seems to be subsiding!
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