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Old 08-16-2012, 04:42 PM   #1
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SteveUK HB User
Macular vision loss after silicone oil removal

Hi all,

I'm new to Healthboards and I'm hoping someone may be able to help with the problem I've recently experienced after 7 months of eye problems and surgery.

I suffered PVD in Jan 2012 in my left eye which caused retinal tears. I had 2 sessions of laser surgery to seal the tears but 1 week after the second session I had a massive vitreous haemorrhage and had to have a vitrectomy with SF6 gas bubble no posturing.

One month later the bubble had gone and all seemed well until my retina detached. I was told it was bad and very close (1.5mm) from the macular detaching too. I was told I was a priority and to come back first thing the following morning for surgery. I arrived at 8am but didn't get treated until 6.30pm - a whole day or stress and worry! This time I had a silicone oil fill and again all seemed well.

I had a follow-up 2 weeks after the operation and my IOP was measured at 38. I was taken off dexamethasone drops and given Acular and Iopodine. The pressure quickly reduced.

Approximately 1 month after the surgery I was fitted with a soft contact lens (+6.5) to bring focus back so I could use my spectacles (I was approx -1 with astigmatism in both eyes). My visual acuity (VA) in both eyes was good as measured by my optician and the hospital.

Approximately 4.5 months after the silicone oil fill I had surgery to remove the oil and also do a cataract operation as this had slowly got worse over the last 1.5 months.

I was very shocked when the dressing was removed the following day to find that my macular vision was very grey and grainy - to the point that I cannot read or see the hands and numbers on a clock, etc. Over the last 4 weeks I've had the usual regime of antibiotic and anti-inflammatory drops but there's been no improvement in macular vision.

I'm concerned that something may have gone wrong when the oil was removed and it's not been explained. The day after the oil removal, when I spoke to the surgeon about my poor vision, he very quickly said that the macular must have been off before. I find this difficult to accept as my VA was very good when the silicone oil was in place. Also, the diagnosis of my condition (I get sent a copy of the letter that goes to my GP) has changed from "macular-on retinal detachment" to "macular-off retinal detachment"!

A couple of weeks later in another follow-up a different doctor asked if I'd had any high IOP. I was conscious during the operation and could hear what was being said and one thing concerns me although I don't know what it means - perhaps someone has more understanding than me? I heard the doctor asking for the bottle (presumably containing the Hartmans solution being fed into the eye to displace the oil) to be set to 60 (is this 60 mBar pressure?). He quickly then said he only wanted it to be set to 60 and not turned on. Could this have exposed my eye to a very high pressure and caused some glaucomic damage to my macular?

I'd be grateful to hear from anyone who has more knowledge on this surgery than I have!

 
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Old 08-28-2012, 03:14 PM   #2
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Laura1000 HB UserLaura1000 HB UserLaura1000 HB User
Re: Macular vision loss after silicone oil removal

Hi SteveUK,
I’m afraid I’m not writing as an expert, but I have also had multiple surgeries including silicone oil fill for recurrent retinal detachment. My silicone oil is still in situ (15 months now) and my surgeon and I are contemplating removal in September.
So I’m writing to you with my support and best wishes and some knowledge I’ve picked up along the way on my 18 month ‘eye journey’.
IOP (Intra Ocular Pressure) is considered normal between 10 and 20. So your pressure of 38 after surgery is high (and if my experience is anything to go by, extremely painful!!). I believe this is relatively commonplace after a silicone oil fill and some people stay on meds the entire time the oil is in situ. My pressure rose after my 2nd vitrectomy and I was taking 3 different pressure reducing drops as well as Diamox (Ugh, terrible pills, terrible side effects, but they do the job!).
It is true that high pressure can damage eyes irreparably, but usually this is associated with long term glaucoma rather than short post surgery pressure spikes. My understanding is that as long as the surgeon controls the pressure afterwards we shouldn’t generally suffer long term.
Again, I’m no expert but having reasonable Visual acuity with an oil fill is considered very good. Most people have poor vision during this time. So this suggests to me also that your macula was functioning well prior to removal and the outlook is promising. When I am standing upright my oil bubble is not lined up for focusing, but when I put my head face down and hold objects very close, I have good acuity, I can read print with it. My surgeon says this is excellent news and I could see his visible excitement when he found out I can do this. He says this shows a good outlook for post oil removal, providing we can get the retina to stay attached! My macula is also working in there!
For this reason, if I was you, I would be seeking a 2nd opinion and fairly quickly. It’s not that your surgeon may have done anything wrong, but that different surgeons have different ideas and approaches to things. My surgeon has seeked advice from others about my case as I have an unusual case of ROP … and I really appreciate him for doing this. I know he is committed to my success, but I also know that ROP has no rule book. What works for one, does not necessarily work for another. Even with perfect execution, sometimes ROP retinas re-detach.
At least if you do talk to someone else, you will have some comfort of knowing you have done everything you can, no regrets, I don’t know about you … but when I look back to 2 years ago, I could not have even imagined the struggle, the journey, the hope & the sadness of recurrent detachments, It really is a journey and you need confidence in ‘your team’.
The other suggestion I can make is one that gives me great comfort. I have found a wonderful optician who has a hospital grade OCT scanner (not to be confused with high street optician retinal cameras). I go there regularly (every 3 months) and they store my scans so we can compare every appointment. We can email these to my surgeon if necessary as well. I find this reassurance helpful in between seeing the consultant.
I’m guessing by your nickname of SteveUK, that you are in the UK. If you are in the south of England I can certainly recommend an optician with OCT equipment and (in my opinion) a brilliant & committed surgeon.
Please feel free to email me off list if you would like any phone numbers.
Very best wishes
Laura

 
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