epiretinal membrane peel & vitrectomy

[naoye]

I'd very much appreciate any advice in deciding whether to have this surgery.  I'm very myopic but, with contact lenses, my eyes are:  L 20/20 and R 20/70.  The epiretinal membrane has been present in both eyes for a few years.  Tests a few months ago showed that it had progressed.  (I've recently developed pingueculae as well.)  The surgery is recommended for my non-dominant R eye.  I haven't been able to read well with this eye for several years because of some corneal warping from HSV and a large floater.  Now, with the membrane, I'm having difficulty reading with both eyes, as well as having to be extra-careful driving, etc.  The surgery will remove the floater and likely improve my R eye to about 20/40.  The major  risks seem to be cataract formation, recurrence of the HSV, retinal detachment and infection.  

What I'm mostly wondering about are more minor risks of the surgery, especially possible side effects that might make it difficult to wear contact lenses (such as drier eyes?) because my vision is poor with glasses.  It would be quite devastating to gain 20/40 vision in my R eye but be unable to wear contact lenses.  I was particularly interested in the comments by JodyJ on this site about "bothersome problems" following this kind of surgery (even with vision improvement to 20/20) and wondered whether Jody would mind elaborating a bit on this - even though everyone likely has a different experience.  If the membrane progresses further, I won't have a choice about the surgery.  But I'm hoping this will not be the case.

[1Rita]

A related discussion, Epiretinal Membrane was started.

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

I can add little to the above discussion.

JCH III MD

[JodieJ]

I'll start out with the positive:  I think you have a lot to gain from the surgery, especially if the ERM in your right eye has increased in density.  If you do opt for surgery, consult the very best retinal surgeon(s) in your area, preferably doctor(s) who have done a lot of these procedures.  If you live in a large metropolitan area or are willing to travel, you might consider getting recommendations from Castle-Connolly's online directory for a small fee (www.castleconnolly.com).  There is new "sutureless" vitrectomy equipment available today which will greatly speed up your recovery.  I've had no problem wearing contact lenses post-surgery.  With no complications, you could be back in your contacts in a couple of weeks or less.  Unfortunately, the surgery exposes your lens to oxygen, causing cataract formation.  (There's been some experimental work with the goal of preventing this.)  However, developing a cataract isn't a terrible thing, especially if you're more than slightly nearsighted or farsighted.  My acuity post-cataract surgery with an aspheric monofocal IOL is about as good as it's ever been--actually better than 20/20.

Unfortunately, I had some post-surgery problems, which were made much more difficult because they apparently fell into a crack between areas of specialization within ophthalmology.  My affected eye teared almost continuously post-surgery, and I noticed that the image size in that eye was larger than the image size in my other eye.  My retinal surgeon (who is probably among the best in the country) responded to these problems by prescribing dry eye remedies to stop the excessive tearing.  More than a year later, I had a medicine cabinet filled with ineffective dry eye remedies (prescribed by several doctors) and a very teary eye.  At that point, I started investigating my symptoms online and diagnosed myself with retinally-induced aniseikonia (described in the literature as a "not uncommon condition."  The cause is a condensation of photoreceptors in the macula, resulting from the ERM and/or the surgery to peel it.)  My efforts to get treatment for the aniseikonia from the 20+ local doctors I contacted were unsuccessful.  Fortunately, a Dutch Ph.D. was able to prescribe a size lens correction online (involving wearing a minus spectacle lens over a plus contact lens), which immediately stopped the tearing; this solution works for me even with only part-time wear.

Although your retina will undoubtedly never be perfect, your acuity can probably be significantly improved with surgery.  There is some evidence that peeling the ILM during ERM surgery (not commonly done unless a macular hole is present) can help you avoid the type of problem I had.

I'd be happy to answer any other questions you might have.  Best wishes.

Jodie