Retinal detachment - Vitrectomy 3 months ago. 20/20 vision but strange flickering in peripheral area and occasional spinning dot or circle in center

[PeterInNJ]

Maybe someone here has experienced something similar (see SECTION A):

BACKGROUND:
I had a large (single) floater last fall (43 years of age, first floater ever, no prior vision issue or surgery - other eye has astigmatism so I got reading glasses 18 months earlier).
The floater progressed in a couple of weeks to cause a darker area (but not blacked out / blocked) in my peripheral vision - I went to ophthalmologist that afternoon suspecting a tear or detachment.
After doing a visual exam (NO B-scan) ophthalmologist said it wasn't a tear or detachment and said still only a floater, especially if / since the "curtain" I described wasn't totally blocking my vision / totally dark (as per my own statement).
Only 30 hours later (middle of evening) I started to get a flashing blob if you will. Went to him again next morning. He saw enough this time to warrant a B-scan.
The scan confirmed a "slight" retinal detachment. (Retinal specialist later said it wasn't slight, although it was not in the macula luckily).
Sent me straight to a top notch retina specialist that same morning - he performed cryotherapy to seal a few tears and pneumatic retinopexy with gas bubbles. Two days later he repaired one more minor retinal minor tear just to be safe.
Everything was great till 4 days later, where things seemed off - got a bubble (air since gas not working on a weekend) and positioned head (differently than before I believe) that day and saw retinal specialist next day  who told me looked great. Went back to slight angle (originally advised position). Two days later it detached again! (Not sure if positioning played a role).
This time I had a vitrectomy with a large gas bubble the next day instead of originally considered scleral buckle surgery (he changed his mind).

POST SURGERY
Fast forward to now - 13 weeks since vitrectomy.
Vision has been 20/20 in operated eye without any lenses for a while now, so I am EXTREMELY thankful for that.
Overall I am very pleased!

STRANGE PHENOMENA SINCE SURGERY:
1. (mostly gone now) a very small spinning / flickering dot / circle in center of vision that occurred about 4 times in 4 days  about one week after the vitrectomy. In each case it lasted a few minutes (less than 5) or so and went away.
Then it went away for a while and never came back (maybe once in 12 weeks) till today (read below).
Today I shoveled the wall of snow from the end of driveway left by plow (we got 16 inches yesterday and did everything else then - driveway, large deck and small path to front door).
When I was done today (obviously exerted myself a bit although surgery was 13 weeks ago) I had a large spinning circle (translucent as usual but much much larger) in center of field of vision.
It again subsided within 5 minutes (didn't time it exactly so not sure how soon it was).
The rest of day today my eye has been fine (i.e. the spinning circle didn't come back at all) with just the usual throbbing / pulsating flash / flicker in peripheral area (maybe optic nerve related or that I am so sensitive since surgery that I see stuff most people don't see) that has been there ever since the experience from weeks ago described below in 2, no better or worse than usual today though.
Ironically yesterday I did a lot more snow clearing with an electric blower NOT self-propelled, some shoveling and also shoveling and throwing snow over deck railing and did not experience anything unsual like what I experienced this morning with LESS effort (both in terms of time and exertion). The one difference is that I worse coated / tinted snow goggles on yesterday and no eyewear today (colleague thought might be light related which is possible).

2. One day I noticed a small portion of my visual image in bottom right was throbbing / shifting.
I went to retina specialist and everything looked fine. She even did a b-scan to be sure.
Then it got to the point where it was a bigger area and to the right (seemed more pronounced in fluorescent lighting).
They checked everything again and did a special retina scan (both eyes) with a machine where you look into the ocular piece focus on a central object and it takes pictures. She said it was so well attached that you could not even tell it was ever detached / operated on!
She couldn't see anything wrong and said she has seen all sorts of weird phenomena after retinal detachment but had not heard of / didn't know what I was experiencing / describing
This was mostly something I didn't notice unless I was looking to the right with head facing straight) and even It still doesn't really bother me

ANYTHING YOU WOULD DO?:
I am wondering whether to see retina specialist now given that they couldn't find anything wrong last time and said everything was perfect (although this time the circle was bigger and I did exert myself more lately - snow removal for hours yesterday and lifted a heavy desktop PC the other day, carried it down and upstairs when taking it to my brother's place and back (by car) although it had been almost 13 weeks since surgery.

I have been to doctors more in past few months than my entire healthy life:
- I have a "2 month since last visit" follow up with retina specialist in about 4 weeks.
- I also had an esophagus espisode recently where food got stuck and needed an endoscopy, turns out to be allergy related condition causing narrowing of esophagus near the top - detected after second endoscopy (both in hospital) and biopsy results came back.
- Also had a rash (ringworm on chest so some anti fungal cream prescribed after 2 minute visit to rule out a tick bite)
- Have my annual physical scheduled soon
- Follow up in a few weeks with GI to see whether flovent is working for my EE.

So despite being in good health, I have had a lot of visits close together due to bad timing / luck.

Not sure what retina specialist will see anyway given that my vision, other than the two strange but "not interfering with my daily life" visual pehenomena, especially since number 2 has onyl happened rarely and number 1 is not something i even notice 95% +of the time.

RESUMING "STRENUOUS" ACTIVITY:
How long is normal  (assuming vitrectomy for RD was successful and vision is 20/20 like in my case)?
[b]I assume that strenuous physical activity is fine 13 weeks after my vitrectomy given that doc said 6 weeks (although he wasn't specific) - I did read online about usual time before resuming sports etc. and believe I am certainly beyond that now - and presumably since my vitreous is gone, there is less / nothing to pull on my retina, leaving only IOP to worry about (in case activity raises it too much), but presumably at this stage of my recovery that should not be a concern anyway right?


Sorry for the long post!





OPTIONAL Side note - I did get (diagnosed with) blepharitis in both eyes due to keeping eye away from water too long perhaps.
No issues (no stickyness or other blepharitis symptoms other than the dandruff on lashes and, perhaps unrelated occasional minor intermittent pain in the non-operated eye which eye doc and I both though could be due to sinusities and not bleph.) which has subsided lately - stopped azasite 2 weeks into 4 weeks since I was concerned about length given my minor symptoms and the fact it is usually chronic anyway - I was doing the baby shampoo margin cleaning daily and took my chances - he had said do 4 weeks of azasite to get condition under control - pharmacist who has been in business for years and knows the eye doc said usually it was 2 weeks not 4 for azasite).
END OF OPTIONAL NOTE








I found two threads (especially the first that could be similar things:
http://www.************.com/boards/archive/index.php/t-245791.html
http://www.medhelp.org/posts/Eye-Care/Constant-flickering-light-in-peripheral-vision/show/923272


This discussion is related to Constant flickering light in peripheral vision.

[MichelleH]

I had a vitrectomy last December and I have that same peripheral flickering even today (late May).  It seems to be slowly getting better.  I have a rough patch where I  had some additional laser (around 11 o'clock) and that part is flickering worse than the other areas- although the flickering is not restricted to there, so I assumed it had something to do with the retina settling down and reattaching with the changed disposition of the eye after vitrectomy.  THe flickering doesn't seem like the ocular migraine mentioned above, at least mine doesn't.

Since I have been told my eyes will take up to 2 years to heal I just assumed this was a part of the normal healing process.

One note for me is that I am in my 40s, this could be a phenomenon that affects the younger people (relatively) who have this procedure?

[PeterInNJ]

Thanks Matt.
Work has been hectic beyond belief lately, but I wanted to thank you for posting and at least write a quick reply.

I don't think what I have is an ocular / ophthalmic migraine for two reasons:
One: The symptoms seem different (mine are [much] less severe / noticeable)
Two: My symptoms don't come and go - it is more permanent BUT doesn't even bother me / disrupt my day to day in any significant way.

I will wait till my scheduled visit next month to ask again. Might be one of those things that never goes away or takes up to a year.
In any case it does not seem retina-related.

I'll try to write more when I have a second to breathe...

[matt_ret_d_vitrectomy]

Thanks for posting your experience.
See your doc, but I suggest you might check out "ophthalmic migraine" or "ocular migraine" on the web.
Also, you could still have floaters or residual gas (unlikely) or residual PFO liquid from the surgery if they used that.  
I can relate, as I had RD in OS treated by cryopexy and gas bubble, followed by more severe RD treated by vitrectomy and scleral buckle with gas bubble. And RD in OD treated by cryo and gas.  It took 13 weeks for all my gas bubbles from the vitrectomy to dissapear, but I still have PFO "bubbles" I can see when I look up at the ceiling.

Also I first realized my small optical migraine was what it was after all this began.
I had no idea what it was before then. My dad said he, my uncle my aunts and grandmother all had them too. Mine looks like a small round area of shimmering, like heat waves above a hot highway.      

[Ray T Oyakawa, MD]

Ask your surgeon. It is hard for me to comment since I have not examined you.  You will probably need some additional tests.

Dr. O.

[PeterInNJ]

PS1: The intermittent, short-lived each time, minor (not throbbing or sever by any means) pain  I mentioned having mostly in NON-operated eye has not occurred again recently despite being on a computer and TV many hours a day.  So maybe it was sinus related or who knows.

PS2: Phenomenon 2 is translucent so vision is not blocked in any way shape of form. I is more like a translucent shifting flashing / pulsing light in the peripheral area (can't be seen at all when I put my hand over my eye in an O shape to form a circle and look through it).
Even when I look all the way to the right (corner of eye) and am looking for it it can sometimes be hard to see and at other times not even there is not much of a nuisance anyway even when it is there (at times it is pronounced enough that I can;t miss it even when looking ahead (unless I put hand over eye so that peripheral vision is not in use since it is in play to a degree even when looking ahead of course).
It is very rhythmic in nature too.