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Old 01-29-2008, 11:07 AM   #1
brianmf
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Macular traction (was Papilloedema+macular oedema)

As my diagnosis has moved on, I decided to open a new thread, with thanks to all those who have offered advice so far.
Unfortunately, I still do not have a definitive diagnosis or prognosis and I am not sure if this is due to a lack of reference literature in the French language (my specialists are all French speaking). All I am being told is that my fluorescien angiography shows a fibrous region of swelling (oedema) on the temporal side of the macula in my left eye with no evidence of vascular problems in the retina.
As the problem started with four months of progressively worsening visual disturbances (stationary lights in darkness) and that those displays ceased when I suddenly developed blurred vision, I would presume that this is macular traction rather than macular pucker. If I understand correctly, macular pucker is a condition that develops slowly after posterior vitreous detachment (PVD) whereas my blurred vision arrived suddenly, as though the vitreous detachment process suddenly released the internal membrane except for a small area that remains attached to the macula.
Perhaps that is an engineer's analysis of the situation but I am on the inside looking out and that is how it feels to me.
Are there any readers here that are experienced in this domain?

Last edited by TopGeek; 01-31-2008 at 08:17 AM.

 
Old 01-31-2008, 08:24 AM   #2
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Re: Macular traction (was Papilloedema+macular oedema)

I visited my opthalmologist again this morning and she told me that my left eye acuity has improved since last week and also that the macular traction is less so she is hopeful that the improvement will continue. She also said that she believes the previous four month period of visual disturbance was not a precursor to the macular traction. That is difficult for me to accept as the two conditions seemed to be absolutely in sequence and affected the same eye.
In any event, I shall be delighted if the improvement continues and that I can avoid surgery.

 
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Old 02-12-2008, 12:57 AM   #3
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Re: Macular traction (was Papilloedema+macular oedema)

One other problem that I've noticed since developing this condition is that I now always have the presence of light, even in a totally darkened room. I have an image of a light orange coloured background covered with swirly black lines.
It looks like old-fashioned flock wallpaper.
This pattern is stationary and remains so when I move my head which shows that it is in my brain and not in my eyes. It's like looking at a screen mounted on a frame fixed in front of my eyes, except that opening or closing my eyes makes no difference.
An MRI brain scan says there's nothing to worry about there so I am not worried about it but it is evidently nothing to do with the macular traction.
Has anyone else here experienced this type of effect?

 
Old 02-16-2008, 05:40 AM   #4
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Re: Macular traction (was Papilloedema+macular oedema)

This is a bit like talking to myself - the ongoing saga. The absence of responses perhaps confirms that my condition is unusual.
The unusual aspect is that my first hospital visit (in November) indicated only papilloedema whereas the second visit, three weeks later, also showed macular oedema/traction.
I saw my opthalmologist yesterday and she insists that there are signs of improvement but they are not at all evident to me. She also told me not to expect complete recovery because the head of the optic nerve is pale, indicating permanent damage. I have a large oval scotoma across the lower right corner of an Amsler grid and she says the aim is to reduce that as far as possible. As I'm having no treatment, I don't quite see how that can be achieved other than by nature following its course.
I have another hospital visit next week with a leading specialist who is probably going to do an OCT scan. Perhaps the picture will be clearer after that.

 
Old 02-22-2008, 12:35 AM   #5
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Re: Macular traction (was Papilloedema+macular oedema)

As is becoming standard experience, my hospital visit yesterday produced no further clues as to the reason for my macular traction. What it did show was that the oedema has gone whereas the macular traction looks quite dramatic on the OCT scan. The left eye OCT image shows an extensive area of space between the retinal layers with a large peak on the right showing the area of traction, which the opthalmologist described as fibrous.
It seems that surgical intervention is necessary to release the traction.

 
Old 02-22-2008, 08:00 AM   #6
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Re: Macular traction (was Papilloedema+macular oedema)

Hello Brian

I am sorry to hear of your ongoing problems and understand your frustration.

What exactly would they be doing surgically to release this traction and would likely outcome would be experienced?

Would surgery resolve the scotoma or leave a permanent blind spot? Have they told you the likely outcome?

Are they trying to fix the current issue or attemting to prevent further damage?

If left to its own devices, is is possible this scotoma would progress or lead to a detachment in the macula area?

I expect you are asking all these questions of your doctors and not getting satisfactory answers. Perhaps they simply do not know.

I feel for you in your predicament. Have they seen this kind of thing before? If not, would you be prepared to travel to somewhere where they have?

I guess in your shoes, I would explore all options before committing to any kind of surgery that does not promise excellent results. or at least get you to a better place, vision-wise, than you are now.

How much is this scotoma affecting your day-to-day life, anxiety aside? When you read, for example, is the scotoma interfering with that?

Do you think its something your brain will tune out by "filling in"? (My brain is not very good at that!)

I wish you all the best. Keep us posted.

Izzy

Last edited by izzy68; 02-22-2008 at 08:01 AM.

 
Old 02-22-2008, 10:10 AM   #7
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Re: Macular traction (was Papilloedema+macular oedema)

Quote:
Originally Posted by izzy68 View Post
Hello Brian

I am sorry to hear of your ongoing problems and understand your frustration.

Do you think its something your brain will tune out by "filling in"? (My brain is not very good at that!)

I wish you all the best. Keep us posted.

Izzy
Thanks for your kind words Izzy. Yes, it certainly is frustrating because the only treatment offered so far was the prednisolone, which almost gave me a heart attack. The proposed operation has no guarantees and I guess any surgery inside the eye has a high risk. However, so does doing nothing. I spoke to my regular opthalmologist last night and she said she thinks it reasonable to wait and see because there has been no increase in the extent of the traction over the last two months. My hope is that it will one day break free but I have no idea if that is possible. Evidently, there is the possibility of it causing a macular hole or retinal detachment.
Unfortunately, none of the opthalmologists seem to know much more than I've already gleaned from the Internet.
I will need to talk to the head of the surgical unit to find out more about the procedure and the likely outcome. From what I have read, it seems that they just slice through the point where the macula is attached to the film enveloping the vitreous. It's difficult to see how they can avoid some damage to the macula in the process.
The scotoma is a symptom of damage to the head of the optic nerve and I think there is little chance of recovery there. I can read OK because I have one good eye but I am constantly aware of the blurring in the left eye and have not seen any improvement in that since November.
All in all, I think the best I can expect is some relief from the awful blurring caused by the traction, either through surgery or spontaneous release.

Last edited by TopGeek; 02-22-2008 at 10:13 AM.

 
Old 04-18-2008, 09:25 AM   #8
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Re: Macular traction (was Papilloedema+macular oedema)

Brian--
I am jsut curious...have you noticed an increase in your fatigue since your vision problems occured??

I have similar viusal disturbances, but from Optic Neuritis. My MRIs have been clean so apparently it is not MS. I am currentlly at 20/70, having recovered from 20/200 in that eye with multiple blind spots in the field of vision. I am now developing optic neuritis in the other eye. (With a sudden initial onset, my vision disturbances seem to worsen over a couple weeks) time...

Since I don't have MS I am attributing the fatigue to my brain trying to make sense of what it is "seeing" and was just curious if you have similar fatigue.

Thanks! Take Care!

 
Old 08-07-2008, 12:55 AM   #9
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Re: Macular traction (was Papilloedema+macular oedema)

Since my vitrectomy operation early in June, there has been no noticeable improvement but, in the last week, I have developed a circle of clarity above the scotoma (so, in the upper right of the Amsler grid). Although the lines inside that circle are sharper than the rest, they are distorted and they move.
I am finding this to be very distracting and I now work at the computer with the bad eye closed most of the time.
My ophthalmologist says there are additional 'folds' in the retina and she is trying to get me an urgent appointment at the hospital.
Meanwhile, I have done some further research and have concluded that this is a condition known as macular pucker.
If anyone here has any specific knowledge on that subject, I would be interested to hear from them.

 
Old 08-07-2008, 12:59 AM   #10
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Re: Macular traction (was Papilloedema+macular oedema)

Quote:
Originally Posted by clem7 View Post
Brian--
I am jsut curious...have you noticed an increase in your fatigue since your vision problems occured??
Yes, I have suffered a lot of tiredness. I put it down to a combination of things: worrying about the eventual outcome, working with one eye closed much of the time, not getting enough sleep, etc.

 
Old 08-21-2008, 05:16 AM   #11
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Re: Macular traction (was Papilloedema+macular oedema)

For the record - the 'urgent' appointment offered by the hospital was for 22 Sept. but with a lot of persuasion I got it brought forward to today. The net result is that a new OCT scan shows I still have some macular oedema but the surgeon can offer no reason for the continuing deterioration in my vision. She says the progress looks normal and all she could offer is treatment with NSAID drops (Pranox) to help reduce the oedema.

Last edited by TopGeek; 08-21-2008 at 11:54 PM. Reason: detail

 
Old 10-28-2011, 05:03 AM   #12
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Re: Macular traction (was Papilloedema+macular oedema)

Quote:
Originally Posted by brianmf View Post
I visited my opthalmologist again this morning and she told me that my left eye acuity has improved since last week and also that the macular traction is less so she is hopeful that the improvement will continue. She also said that she believes the previous four month period of visual disturbance was not a precursor to the macular traction. That is difficult for me to accept as the two conditions seemed to be absolutely in sequence and affected the same eye.
In any event, I shall be delighted if the improvement continues and that I can avoid surgery.
hope your eye has totally cleared up. I have a very similar problem.
diagonis was two month ago, "retina refraction detachment", vitreous gel that should normally slide off my retina, is attaching and causing my central vision to go. The retina dr's. say that it may get better on it's own, but if not, surgery to remove the gel is the only alternative. and there are always risk with surgery. How long did it take for you vision to get better? or did you have surgery? I'm curious, since your case sounds very similar to mine.
Thanks so much for any info you can share.

 
Old 11-01-2011, 01:04 PM   #13
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Re: Macular traction (was Papilloedema+macular oedema)

Quote:
Originally Posted by brianmf View Post
As is becoming standard experience, my hospital visit yesterday produced no further clues as to the reason for my macular traction. What it did show was that the oedema has gone whereas the macular traction looks quite dramatic on the OCT scan. The left eye OCT image shows an extensive area of space between the retinal layers with a large peak on the right showing the area of traction, which the opthalmologist described as fibrous.
It seems that surgical intervention is necessary to release the traction.
Did you have the surgery, and if you did, would you please share with me your experience? I'm thinking about having surgery to remove vitreous gel from my retina and I would really like to talk to someone who has had similar surgery.
Thanks so much.

 
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