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Old 02-16-2013, 07:38 AM   #46
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

So glad you got your OCT's and sounds like you have already made good use of them by becoming educated. I am really no expert, just self educated and it's been about a year since I really delved into the research, so I am losing some of the details in my memory. I mostly watched my OCT's for retina/macula swelling. Mine is still thick (400 vs healthy 250-300ish range) but I don't have CME. You can see the CME because it is like a pocket of darkness within the retina layers.

You should also be able to see your scar tissue/ERM if one is there or forming.

In regards to the difference in Diopters, I was just told one diopter per eye...surgery eye ended up -.50 and good eye +1...I assume they are distance measurements. If you are seeing well, I wouldn't get hung up on the numbers so much. Also, many have said to actually stay within 3 diopters to be safe, but also read that the 2 diopter spread was best to be safest. Everyone adapts differently depending on what they were used to before the surgery so these are just guidelines.
You sound a lot like me...I was a "sponge" absorbing any and all information I could get on my eye.
Keep it up, information is power.

 
Old 02-16-2013, 12:08 PM   #47
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

tubint: Yeah, once these eye troubles (cat+RD+cat/vit sx) started happening to me I have been reading voraciously about them with whatever I can get my hands on - via internet, as well as, sometimes medical books in the local university, library or book-store...of course, with whatever eye is functionally working at that time . Although it satisfies my curiosity about these things (and the medical research on retina, in particular, is truly a fascinating field), my real reasons are (a) Is my vision going to improve at all in the near or distant future? (b) What are the options to improve it, and how can I implement them? and, (c) What are the root-causes for my particular trouble? Hunting for the best surgeon and clinic is a different issue though, where, "HealthGrades" is a good web-site. But, finally, no matter how much we think we know about a particular eye problem, we need to rely on professionals (surgeons, and optometrists in the end) to take care of it. And, once you yourself go through these eye-opening surgeries (literally) and get your vision back, completely or somewhat, you truly start admiring these skillful eye surgeons, and the medical profession, in general. And, when it doesn't improve, it's a wholly different story...(Btw I didn't know what CME was, but wiki has a lot of stuff on it, and I am sure you have already read a bunch on it.)

Last edited by vitcat2; 02-18-2013 at 07:01 PM. Reason: typo

 
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Old 02-18-2013, 07:29 PM   #48
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

I wonder if the features of the macular cross-sections in my OCT scans on the two perpendicular axes at the fovea (one from nasal to temple, and the other from top to bottom at right angles to the first one), which are quite different from each other, can explain the differences in my perception of the horizontal and vertical lines. Both lines appear wavy and wiggly but the vertical lines have more of it - can that correspond to the vertical c/s on OCT scans? This combined with the "edge-detection" algorithm of the brain/eye/cone cells must have something to do with the different waviness/wiggliness perception.

Also, when I focus my attention on a thick black line, then its edges seem to be eaten out with "arcs," wherever I focus, and when I move my gaze along this line, this wiggliness moves with my gaze. If there are two parallel vertical lines closeby, like, bathroom tiles, then they appear closer to eachother where my gaze is at that moment (classic coke-bottle shape). If the line is diagonal, then I see a diagonal but a chopped-up line like an old-time PC dot-matrix ink printer. I write in detail these observations because it is not going away still (almost 6 weeks after vit sx), and I am becoming more and more aware of it, and frustrated. Has this happened to anybody else? Did you have to live with it, or did it go away after several months, may be, years on its own? I hear there is a medicine and injection-dose for reducing this waviness/wiggliness. But these symptoms can happen due to many other eye diseases, not just macular detachment, so I wonder if they apply in my case. Any thoughts?

 
Old 02-20-2013, 03:56 PM   #49
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

I was told yesterday by my Opthamologist, that if I end up having a tear and/or detatchment in the retina, that I will require a Buckle and will be Miserable for years. Does anyone know what he means by Miserable for YEARS? He did not elaborate and rushed me out of the room before I had a chance to run his precious time over 10 minutes of "talk" I even skipped the exam because all I wanted was a CONSULT.
What would cause YEARS WORTH OF MISERY....not being able to see?......Pain?....Sleeping upside down.....not sleeping at all? The year is now 2013, anyone with fairly recent experience within the past several years worth lf experience in Misery from a Retina Buckle? Thank you thNk you thank you everyone! Mary

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Old 02-20-2013, 03:58 PM   #50
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

mlsano: It's CME, not CMD. CME stands for "cystoid macular edema," which 'tubint' says he has. It's the swelling on the macula due to a cystoid - search wiki again for "macular edema," better yet google it for more info. It can be seen on your OCT scans - these give the thickness distribution of your retina (cross-sections) in the central (macular) region from ILM (Internal Limiting Membrane the innermost retinal layer touching the vitreous ) to RPE (Retinal Pigment Epithelium - the outermost retinal layer touching the choroid) in different regions. If this thickness is larger than "normal" then, I think, they call it an "edema." This macular thickness is on the average about 300 micro-meters, or 0.300 mm, but at the foveal pit it is less, like, 0.255 mm; there is also a small volcano-like "mound" around the fovea itself which has higher thickness than elswhere, but that mound itself is very small in area.

Although my right eye has an ERM (some small wrinkles in the macula), the thickness is not that abnormal; on the other hand, my left eye has no ERM, but, 4 weeks after vit sx, it has portions which have slightly higher than normal thickness (beyond 95% normalized distribution). But, if you don't have CME, you don't need to unnecessaily bombard yourself with this info. However, discussing your OCT scans with your dr may help understand your particular situation.

 
Old 02-23-2013, 02:27 PM   #51
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

Hi OP. I'm in a similar position and hope you the best.

I am 31 years old and have been diabetic since I was born. 3 Years ago I had a partially detached retina in my right eye which was repaired with laser. A month ago the eye re-detached and I was forced to get a vitrectomy with C2F6 gas. 1 week later the eye re-detached and they performed the surgery with C3F8. This lasted up until 2 days ago when the eye began to re-re-detach. I am now scheduled to go in for a 3rd vitrectomy, this time with oil, on Monday.

What really concerns me is my employer went out of business a few weeks before the first detachment in January. Yesterday I received a letter in the mail saying our insurance group policy was cancelled by the bankruptcy appointed trustee and that at the end of February our insurance will be cancelled, regardless of whether we already paid for COBRA coverage or not. This means I will be trapped with silicone oil in my eye but uninsured and unable to have it removed. This has me very concerned.

As for results, I too see extreme waviness in the repaired eye following both vitrectomies. My OCT looks like a steep plateau in the middle. My doctor said it may have been caused by the surgeon when he tried to flatten out the retina. I also suffer from extreme double vision after both surgeries.

Does anyone know how long the oil can be left in the eye? How is living with the oil in my eye. Some have described it as being drunk, others as being dizzy or sea sick or trying to walk on a moving train or boat. What do people think of having oil left in the eye indefinetely?

Thanks

 
Old 02-23-2013, 05:36 PM   #52
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

Hi VIT: I do believe the message you received was for M27. Vitrectomy was also in one of my readings on complications of cat. surgery along with detatchd retina, because my nearsighted rx is high almost at 10 my dr. is scaring me to death with these "possible complications" anyway I will go back and read your original post (and mine) as you were kind enuf to respond: good luck with yours as well, at least I am finding we are not alone in this world, not that it makes our problems any less troublesome. Best again, mlsano

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Old 02-24-2013, 06:46 PM   #53
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

Hi cknite,

I really sympathise with you since you have already gone through multiple retinal detachments and vitrectomies at this young age, and have fallen into this insurance predicament.

Although I do have some double vision after the vit sx., it does not sound as bad as yours, as I am recovering most of my stereoscopic vision, especially, at smaller distances (like office space or at home, etc.). The dr says the latter will improve somewhat when I get my prescription lenses (presently, I am using none just because of the other dominant eye, but I know I need one for the operated eye). So, perhaps your double vision may also improve with time. Unfortunately, I have no experience with oil replacement in the eye - I had the usual air bubble, which promptly vanished in 2-3 weeks. The silicone oil is usually used instead of air bubble for more difficult and repeated RD cases as yours, or patients who cannot be in face-down position. But it is removed after few weeks/months. You should talk to the dr about its bad effects if left too long. How's your vision with it? Can you drive and all?

By the way, if you are without job and insurance, there is the (government) COBRA insurance which you should look into, which people can use for 18 months or so when they find themselves suddenly out of job and insurance. There are some nominal monthly premiums, and the coverage may be smaller than your usual company-sponsored insurance. But, I think, if I were you I would still use it to the fullest for taking care of my eye rather than leave it to chance. I am sorry I cannot be of further help to you, but I sincerely hope somehow you will come out of this with improved vision.

 
Old 02-24-2013, 07:26 PM   #54
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

Hi vitcat2,

Thank you for the response and the sympathy. I really do appreciate you taking time to respond and hope you the best in your recovery. Hope your stereoscopic vision comes back and you end up with no double vision.

The irony of it all is that the day before the most recent detachment, I had visited the dr and he said he really didn't think the retina would re-detach at that point. Then the next evening I noticed a sudden and increasing loss of brightness in the eye. From my understanding the oil is much more likely to cause a cataract. I'm assuming the length of time the oil is left in the eye is proportional to that likelihood but I will ask the surgeon tomorrow.

As for COBRA, I was employed until the week before Christmas when we were notified the company was bankrupt. I went ahead and paid COBRA out to June. Three days ago I received a certified letter from the trustee assigned to liquidating the assets of my former employer which said that they were cancelling the COBRA group policy as the liquidation of the firm had been finalized and hence there was no reason to continue servicing the plan. Now I've got to figure out who to call to get my COBRA money refunded for that...

My appointment is tomorrow. I am going to ask about the risk of leaving the oil in for a while as you suggest.

I am going to look at this as a good thing since the Dr said of my steep OCT ridge that the only solution would be a 3rd attempt and with the retina looking so good (at the time) it would be inadvised to detach the retina and try again. This way I'm getting that 3rd chance at a flat retina without having to take a gamble and go for an otherwise unneeded procedure.

 
Old 02-24-2013, 07:29 PM   #55
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

Hi vitcat2,

Thank you for the response and the sympathy. I really do appreciate you taking time to respond and hope you the best in your recovery. Hope your stereoscopic vision comes back and you end up with no double vision.

The irony of it all is that the day before the most recent detachment, I had visited the dr and he said he really didn't think the retina would re-detach at that point. Then the next evening I noticed a sudden and increasing loss of brightness in the eye. From my understanding the oil is much more likely to cause a cataract. I'm assuming the length of time the oil is left in the eye is proportional to that likelihood but I will ask the surgeon tomorrow.

Here in IL we have what's called HIPAA-iCHIPS which is for those who have lost COBRA for one reason or another. I've gotten the application submitted and should hear back in the next couple weeks.

My appointment with the surgeon is tomorrow. I am going to ask about the risk of leaving the oil in for a while as you suggest.

I am going to look at this as a good thing since the Dr said of my steep OCT ridge that the only solution would be a 3rd attempt and with the retina looking so good (at the time) it would be inadvised to detach the retina and try again. This way I'm getting that 3rd chance at a flat retina without having to take a gamble and go for an otherwise unneeded procedure.

 
Old 02-24-2013, 09:04 PM   #56
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

cknite: "...The irony of it all is that the day before the most recent detachment, I had visited the dr and he said he really didn't think the retina would re-detach at that point. Then the next evening I noticed a sudden and increasing loss of brightness in the eye. From my understanding the oil is much more likely to cause a cataract. I'm assuming the length of time the oil is left in the eye is proportional to that likelihood but I will ask the surgeon tomorrow...."

The dr is only human - my dr also said after a preventative laser retinopexy and posterior vitreous detachment (PVD) that there was no retinal tear, the vitreous was completely floating (harmless), and the chances of retinal detachment happening is small. However, in 2.5 weeks, within 7 hours my vision blockage went from 10% to 90%in that eye and RD had happened. I got vit sx 24 hours after all this happened - but my macula was detached by then, hence, all the emergency havoc later, and I am left now with distorted vision. So, all these are also guesses by the dr. I had earlier read the recommendations of "American Academy of Opthalmology," about doing even the laser retinopexy as a preventative treatment, and the panel was divided into whether to do it or not, and I was myself in a predicament then. I sometimes wonder if the RD actually was accelerated due to this "preventative" laser treatment. So, all these are nature's games, and your luck! By the way, even if cataracts happens later, don't worry much, since it is a much easier operation than vit sx - and the results are quicker and better; however, cat sx itself also is supposed to increase the possibility of RD - so, unfortunately, it is a boot-strap loop. Perhaps, you may take second opinion, and even a third, since you are going through so many RD's and vit sx.
By the way, I did not quite understand the ridge in your OCT; usually, at the fovea it is more like a volcano pit - with a depression in the middle and a mound at its rim, with slowly decreasing thickness beyond the mound. What ridge are you talking, and why is it good?

 
Old 02-24-2013, 09:17 PM   #57
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

The ridge is the result of wrinkle in the retina when it was re-attached during the vitrectomy. Ther OCT showed a literal 45 degree line upward near the center of the vision which then plateaued a little before smoothing back down to normal. Seemed to me to look almost like a wrinkle that got bunched up. It's only good that since I've experienced a 3rd detachment, there's a chance this time around the wrinkle will smooth out this time. Before the detachment, my only option was to have a 3rd vitrectomy only to solve the wrinkle. Now, I'm getting the 3rd vitrectomy either way and hoping the wrinkle is smoothed out this time.

 
Old 02-24-2013, 09:34 PM   #58
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

sree234:

By size, do you mean the diameter of the macular hole near the central fovea? Units for these retina-related things are in "mirometers." That is, 622 micro-meters, or 0.622 mm in your case. Don't be fooled by the smallness of this size - everything there is really, really small, but the vision from the fovea (it is just 0.3 mm in diameter, and can have 175,000 cone cells in 1 sq. mm - cones are densely packed only in the fovea and give color perception and visual acuity) occupies 50% of the imaging from the visual cortex in the brain; rest of the imaging is for rest of the retinal area! (See some of the numbers I have mentioned in my other posts in this thread.) By the way, do you have macular edema (swelling) too?

Also, ask your dr if it was really a "hole" in the macula, or macular "detachment" but not really a hole (see my other post on it: Stage 1, 2 and 3 - see NEI website on this) - the rate of recovery and the final state of vision can be different in both cases. I had Stage 1 macular detachment, and I am still recovering after 6.5 weeks. An OCT scan tells a lot of things about the retinal cross-sectional thickness distribution, amongst other things - it is done in just a few minutes, and totally painless. But with the air bubble still in there, I don't know if they can do that yet. They use infra-red light and ask you to focus on a cross-hair through a desk-top machine, and get the OCT. Macular hole, even after repair, usually causes some vision distortions - which I am going through myself (that's the reason I started this thread -read my first post), and still keeping my fingers crossed for full recovery. Waviness of vertical/horizontal lines, image size distortion, and stereoscopic vision are the main problems - dr says time will improve them, but perhaps not completely. If your other eye is good, you are in luck, since it will simply dominate most of the vision, as in my case, and I can do everything normally otherwise. It's the coordinaion of both eyes in the brain that's the issue!

 
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Old 02-25-2013, 06:53 AM   #59
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

Quote:
Originally Posted by vitcat2 View Post
I have had vitrectomy with retinal repair (laser+cryo retinopexy) done on my left eye about 3 weeks ago for retinal detachment. There were multiple retinal tears at the top left portion (9:00-12:00), as well as the bottom 7:00-8:00 sector, despite having gone through a preventative 360-degree laser-retinopexy. The surgeon said that the cone cells at the fovea, which gives visual acuity and color sensation, and is inside the central macular region, were also involved in the detached portion but there is no sign of ERM (epi-retinal membrane). The air bubble was gone on the 18th day, and my previous vitreous with floaters has now been replaced fully by saline solution and body's natural fluids. The surgeon says the retina has also been re-attached properly and is becoming flatter and flatter against its base (RPE - retinal pigment epithelium). So far, so good!

I can now see most of the things with that eye but have the following vision distortions, whence, this post:
(i) image is slightly smaller and displaced (double vision) than that from my other eye (which has 20/20 vision)
(ii) it is also wavy (vertical and horizontal lines look wavy), and
(iii) not that sharp (it was 20/50 on the 16th day, and improved somewhat with the screen-with-hole test; reading improves somewhat with my old reading glasses with +1.5D; words on the computer screen or book look wiggly though). Due to the image displacement my "depth of field" perception was not that great but is better now than a few days ago, so that I could start driving on the 19th day - the further the objects, the larger is the image displacement from the other eye. I should also add that the same eye also had cataract surgery some 11 years ago with the artificial lens (IOL) giving me 20/20 vision before the retinal detachment happened. Further, the other eye (right) also has gone through cataract surgery (11 years ago), laser retinopexy for retinal tears, and vitrectomy/retinal-repair surgery for peripheral retinal detachment (6 months ago), has ERM now, but I got back 20/20 vision in about 2.5 weeks. I guess for most of my daily activities my "dominant" right eye must have taken over since I feel comfortable driving and walking around now. The doctor said that I should wait at least 6 weeks before getting any corrective lenses for my left eye, and it may take weeks/months before the left-eye vision stabilizes.

My questions are the following (in order of importance):
1. Can the image-displacement problem (double vision) and difference in image size be rectified with corrective lenses? The double vision appears to be the more annoying problem presently.
2. Can the visual acuity in both far field and near-field be improved at all, in terms of wiggliness/waviness?
3. Has somebody else gone through similar vision problems after vitrectomy+retina repair, but largely gotten back their depth of field and visual acuity? Any success stories?
4. Having gone through these retinal repair surgeries, what's the possibility of getting retinal detachment again?
5. If I already have IOLs in both eyes, can cataract-related disease happen again because that seems to be the most common post-vitrectomy problem?

Thanks for reading through my long post, and I will appreciate any input from you. This has been a long, arduous journey, and I am only 58 years young.
Hi Vitcat,
You have really been through a lot and I can sure appreciate it.
I had the retina repair in 2011 and just had cataract surgery last week.
My vison is greatly improved, but the wavy lines from my retina repair are still there and I'm think they will probably always be. I'm just thankful for the clearer vision after the IOL implant, but I don't know of anything that will help the wavy stuff.
hang in there,
eyemar,

 
Old 03-01-2013, 04:26 PM   #60
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Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment

It has been 7 weeks after my vitrectomy surgery for a macular detachment, and I got some good news from the doctor today: my vision improved to 20/30, and with the screen-with-hole test all the way to 20/25! Full 2 lines better on the eye chart from my visit 4 weeks ago. I thought I will share this positive news with this group, especially, for those who are going through the post-op period after vitrectomy, or, are planning to have it after retinal detachment. The doctor said that if I don't feel like getting prescription lenses, there is no reason to get one, as the diopter number will be pretty small, and the other eye is just fine. However, my waviness/wigliness in vision, especially, while reading a book, etc., hasn't gone away, and he said it may take a while for that. Both eyes are competing now when I read, and sometimes I see two images in near vision; the depth of field also has improved resonably well. These were all the questions I had when I started this thread.
A small side-note to this all was that the doctor noticed some cloudiness slowly growing on my IOL capsule (secondary cataract), and although it does not bother my vision now, he said it will have to be removed at some time in the future. Having gone through secondary cataract surgery with my other eye, I don't worry about it now...whenever it becomes bothersome I will get the Yag laser surgery done.

 
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