It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Eye & Vision Message Board
Post New Thread   Reply Reply
LinkBack Thread Tools
Old 04-05-2013, 12:55 PM   #1
Junior Member
(female)
 
Join Date: Apr 2013
Posts: 10
Er245 HB User
Vitrectomy- Experience & Questions

I am posting on behalf of my mother who is going through a series of eye issues. Firstly, she has been operated for cataract on both eyes. Within a year after that, her right eye developed stage 4 macular hole. For this she underwent gas bubble vitrectomy in Nov 2012. the surgery was successful as she was careful with the posturing and her hole closed. While she was being diagnosed for macular hole in this eye, many doctors also hinted on stage 2 macular hole in the other (left) eye. However, the OCT showed normal findings.

In Jan 2013, finally her eyesight fell in the suspected eye and she was diagnosed with a macular hole (also stage 4) in the other eye too (the left one). Now as a normal procedure, she underwent gas bubble vitrectomy in this eye too. She was this time not very careful with the posturing (head down). After 3 weeks followup, her OCT showed closure of hole while her bubble was around 50-60 % of original size.Her eye sight was almost recovered.
Now at the end of 4th week, she noticed the bubble breaking up unusually and she could see 2 pieces on the upper part of eye (around eyelid). This was followed with the bubble spreading all over the eye. Upon visit, the doctor informed that the hole has reopened!!!He was really surprised since this was very rare after 1 month of successful closure though he concluded the lack of posturing must be the reason.
So this time vitrectomy was performed the very next day and silicon oil was used. Doctor also mentioned the gas going through the hole and tearing up the retina too so in addition laser was also used. Her first week followup was satisfactory and the OCT findings show the hole is closed.

--- However, she has noticed that one of the bubble 'piece' / 'hair braid like blackish thing' has persisted from the earlier vitrectomy complication. This piece is not visible when she sees straight and only becomes visible when she is looking from certain angle and now is visible from even lesser angles and disappears when she lifts her eyebrow!. She mentioned to the doctor earlier but he didn't seem to be worried. So now she is almost 10 days post surgery and it is still there. Is it something some one else also experienced? Anyone who could explain/ share experience related to it?

--- Also, since few days she sees the washroom tiled floor outlines a little wavy. this is AFTER the normal OCT finding from first week followup visit. Is this due to oil or something else? Any explanations?

Last edited by Er245; 04-07-2013 at 01:15 AM.

 
Reply With Quote
Sponsors Lightbulb
   
Old 04-05-2013, 01:00 PM   #2
Junior Member
(female)
 
Join Date: Apr 2013
Posts: 10
Er245 HB User
Re: Vitrectomy- silicon oil

Waiting anxiously for replies!!!

 
Reply With Quote
Old 04-07-2013, 03:58 PM   #3
Member
(male)
 
vitcat2's Avatar
 
Join Date: Jan 2013
Location: Seattle, WA, USA
Posts: 87
vitcat2 HB Uservitcat2 HB User
Re: Vitrectomy- Experience & Questions

Having been a macular-hole patient for both eyes and successful vitrectomies for retinal repair using air bubbles, I have read about 3 stages of macular hole , but haven't heard about Stage 4. What is Stage 4 macular hole?

Thanks.

Last edited by Administrator; 04-08-2013 at 10:59 AM.

 
Reply With Quote
Old 04-07-2013, 04:06 PM   #4
Member
(male)
 
vitcat2's Avatar
 
Join Date: Jan 2013
Location: Seattle, WA, USA
Posts: 87
vitcat2 HB Uservitcat2 HB User
Re: Vitrectomy- silicon oil

Since I still have wavy/wiggly vision issue with my left eye post-vitrectomy for the past 3 months now, I researched a little bit for the reason, and have written about it at length in another post just yesterday. Please read that - it is a neuro-optical "edge-detection" issue, not just a retinal problem. And, unfortunately, it may take several months to a year to go away, if at all, depending on the severity of the macular hole, so says my dr.

 
Reply With Quote
Old 04-08-2013, 06:51 AM   #5
Junior Member
(female)
 
Join Date: Apr 2013
Posts: 10
Er245 HB User
Re: Vitrectomy- silicon oil

Quote:
Originally Posted by vitcat2 View Post
Since I still have wavy/wiggly vision issue with my left eye post-vitrectomy for the past 3 months now, I researched a little bit for the reason, and have written about it at length in another post just yesterday. Please read that - it is a neuro-optical "edge-detection" issue, not just a retinal problem. And, unfortunately, it may take several months to a year to go away, if at all, depending on the severity of the macular hole, so says my dr.
Thankyou so much for the information. I'l definitely read it. Btw my mom had an appointment today finally, so about the wavy lines, doc couldnt say much. He wants her to posture as regualrly as possible and to just hope for complete recovery.

And about the 'dark thread like thing' my mom has been seeing, apparently this is the residual bubble from the previous gas bubble vitrectomy.
I really have few questions for you here since I know you have been through all of this and had been researching around a lot:

1) Did you ever read of any one else complain about the residual bubble from previous vitrectomy?
2) What could be the fate of this residue and will it dissolve? (I'll try to research over the properties of silicon oil used but asked jsut in case you knew already)
3) Did you exprience any dark particles floating in silicon oil? or settled at the bottom? Is it normal?

Thanks again for replying

 
Reply With Quote
Old 04-08-2013, 07:36 AM   #6
Junior Member
(female)
 
Join Date: Apr 2013
Posts: 10
Er245 HB User
Re: Vitrectomy- Experience & Questions

I guess it has to do with different method of classifications of stages of macular hole. But if you research over the internet you will find stage 4 mentioned many times.

Last edited by Er245; 04-09-2013 at 03:31 AM.

 
Reply With Quote
Old 04-10-2013, 12:56 AM   #7
Member
(male)
 
vitcat2's Avatar
 
Join Date: Jan 2013
Location: Seattle, WA, USA
Posts: 87
vitcat2 HB Uservitcat2 HB User
Re: Vitrectomy- silicon oil

For both eyes, I had air-bubble post-vit, so don't know much about silicon oil, except that it is used when face-down posturing becomes very difficult for some patients, as, perhaps, in your mother's case. The oil, just like the air-bubble, holds the eye-ball shape after the vitreous has been removed from it, and presses on the retina for it to stick to its RPE base if there is detachment. But, unlike the air bubble being naturally replaced by the body fluids (saline solution) in 2-3 weeks, the oil has to be surgically removed after a few months, as you may know. Actually, that is also precisely the reason why face-down posturing is not needed when oil is used as it completely fills the eye and does not go "against" the gravity like the air bubble can if it is floating inside the saline solution and be away from the detached portion or hole if the face-down posturing is not done properly.

By the way, I have read elsewhere that the air bubble can sometimes be broken into two - the eye-ball's complex obloid 3-dimensional shape can do that, and that depends also on whether face-down posturing was followed strictly or not, and how much the patient's face moves. Last time I used to see ripples on the surface of the air-bubble, especially, when I looked down at the sink while brushing my teeth. But there is no bubble with silicone oil, so there is no question of the bubble breaking. And, I don't know what the "residue" with an air-bubble is, since the air bubble is fully replaced by the body fluids automatically. Ask your dr if it can be due to "scarring" due to the laser retinopexy which is usually done to stick the retina back or close the hole during vitrectomy, or, naturally due to "lattice degeneration." Another thing my dr told me was that the "particles" that one sees pre- or post-op (and, I still see one or two of them), if they are dark black and with very well-defined shape (polygonal), and not like the usual floaters (stringy or specks-with-gray halos), are actually RBC's (red-blood cells) that have been torn away from the retina. Many times the dr cannot suck away all the previous floaters or debris inside the eye during vitrectomy, and they remain. Ask your mom to describe its shape - if I focused enough, I could literally draw the odd polygonal shape of those particles. By the way, another completely different reason for the waviness is "age-related macular degeneration" which an "Amsler grid test" can show. But, having gone through this test post-vit, the waviness due to retinal detachment, I understand, is quite different than that seen by an ARMD patient - but just check it out with your dr that ARMD does not exist.

I don't know if this knowledge helps, but somewhere it gave me closure just knowing why certain things were happening to me post-vit. I hope your mom starts seeing better and better as the days pass - it takes time.

Last edited by vitcat2; 04-13-2013 at 01:56 PM.

 
Reply With Quote
Old 04-10-2013, 11:16 AM   #8
Junior Member
(female)
 
Join Date: Apr 2013
Posts: 10
Er245 HB User
Re: Vitrectomy- silicon oil

Sorry I was under the impression that you had silicon oil vitrectomy. My bad. Still thanks a lot for sharing all this very useful information.

The decision to use silicon oil was because when the macular hole RE-OPENED after 1 month of it staying successfully closed, the gas had gone through the open hole and actually caused more damage i.e retinal tear. So he explained using silicon oil will be a better option now with this damage and also we had been planning travel. Silicon oil as you may know is safe with flights.

Since doc still cant believe the hole reopeened and it was a huge blow for us since she recovered her eyesight upto 6/9!!!he's been extra cautious this time and has strictly recommended head down posture even with the oil. Which I guess is a good thing to stay on the safe side.

About the residue bubble, what the doc explained was that some broken air/bubble has stayed on and he was not able to clear it before inserting oil. So maybe thats the 'residue'. I was also confused as to if its a floater but I guess one has to trust the doctor. And yes my mother explains the shape well. Its like a tightly wound thick braid/ rod like which is almost black in color.
And yes gas bubble does break down as my mom has also experienced it happening during her successful surgery.

Thanks for explaining about the tiny daark specks/ small particles throughout. With the shapes you describe they are probably RBCs and debris since mom used to see the same specks during her gas vitrectomy.

Actually with the macular hole in her other eye, the hole had been there for longer (for around 6 months) and for that eye she had all these typical macular hole symptoms e.g wavy vision and central vision loss. But with this eye, the macualr hole developed just within 2 months (from stage 2 to 4) so until the retinal tear complication arose, her macula wasnt in the condition where she would have 'wavy' vision. Thats why probably the doctor didnt discuss ARMD possibility and the waviness is probably as I read everywhere due to the retina settling down (recovering) after a tear (as in our case) or detachment. Though thanks to your post, we would discuss the possibilities and the future would tell how it goes.

Thanks again for clarifying on many things and really wishing you complete recovery aswell.

And if anyone else has gone through silicon oil vitrectomy, I hope they share their experiences aswell

 
Reply With Quote
Old 04-11-2013, 12:32 PM   #9
Senior Veteran
(female)
 
Join Date: Jan 2002
Location: Detroit Suburb
Posts: 1,056
Eagle HB UserEagle HB UserEagle HB User
Re: Vitrectomy- Experience & Questions

Thanks for your report, helpful to all of us who may some day need vitrectomy, maybe when we're old enough to have arthritis, which it seems would make face down healing impossible, nice to know there's an alternative, and I certainly hope she has complete recovery. Please keep us posted, and good luck on your having used the floor tiles as an Amsler Grid. A sense of humor is "the American way", to help with stress, y'know.

 
Reply With Quote
Old 04-12-2013, 05:52 AM   #10
Junior Member
(female)
 
Join Date: Apr 2013
Posts: 10
Er245 HB User
Re: Vitrectomy- Experience & Questions

Thanks .. The floor tiles were not used in place of amsler grid rather she happened to notice the tiles as a random observation confirming wavy vision

 
Reply With Quote
Old 04-12-2013, 06:56 AM   #11
Member
(male)
 
vitcat2's Avatar
 
Join Date: Jan 2013
Location: Seattle, WA, USA
Posts: 87
vitcat2 HB Uservitcat2 HB User
Re: Vitrectomy- Experience & Questions

Interesting discussion on the "Amsler grid" test! When I also noticed the wavy lines the first time with my left eye post-vitrectomy for macular detachment, it happened to be on the tiles of our bathroom wall - wherever your gaze is at the moment they appeared wavy, and as you move your gaze along a vertical tile line that portion appears wavy, hence, I felt the whole line is wavy, and two neighboring parallel lines appear "pinched." The horizontal lines are different - they appear chopped, like, sharp little zig-zags, wherever your gaze is at the moment, as somebody else has also noted on his post here. Thick vertical (black) lines appear as if their edges are eaten away by arcs wherever the gaze is at that moment. Does this description also match with others who have experienced it? I am also still looking for the root-cause of this phenomenon, and, more importantly, anxiously awaiting the day when it goes away! It's been 3 months now. It was because of the actual Amsler grid test results, that they did an immediate OCT scan on my left eye, but found that the ILM (internal limiting membrane) of the retina was okay.

The ARMD patients, I referred to earlier, as I understand from the wiki, see a "contorted," "cork-screw-type" Amsler grid, wherever the gaze is at the moment, not just simple waviness. So, there could be 101 reasons why waviness appears in one's vision.

Last edited by vitcat2; 04-12-2013 at 07:00 AM.

 
Reply With Quote
Old 04-13-2013, 02:15 PM   #12
Member
(male)
 
vitcat2's Avatar
 
Join Date: Jan 2013
Location: Seattle, WA, USA
Posts: 87
vitcat2 HB Uservitcat2 HB User
Re: Vitrectomy- silicon oil

Looking back at your post, I am a little bit puzzled as to how the air-bubble can open the pathway from a retinal tear or a hole to a retinal detachment. It's the saline solution or the vitreous humor that goes behind the retina through the tear and cause it to "peel away from its base, like, a wall paper," but not the air bubble itself. That's precisely the reason why the face-down posture is a MUST - the air bubble is supposed to keep the lasered seal around the detached retinal hole or tear near the macula (which is on the back side of the eye, right in the center) in tact, and the liquid is kept diametrically away from it and is near the lens side. May be, I am missing something...

Also, if the residue looks more like a "hair-braid," as you describe, then it does not sound like the flat, black polygonal particles that I am talking about (the RBCs); it could be a remnant of the vitreous itself which may not have been completely sucked out during the vitrectomy operation. I have seen you-tube videos of it. The vitreous is usually attached to the retina with millions of fibres, and when it becomes naturally detached it may leave some of those fibres on the retina and which, perhaps, may appear like hair-braids. Of course, this is my own hypothesis, and I am no doctor. Your doctor should be able to directly see all these things with his opthalmoscope. Still residue from an air-bubble sounds kind of weird to me...

Last edited by vitcat2; 04-13-2013 at 02:16 PM.

 
Reply With Quote
Old 04-14-2013, 11:47 AM   #13
Junior Member
(female)
 
Join Date: Apr 2013
Posts: 10
Er245 HB User
Re: Vitrectomy- silicon oil

Let me explain again. In chronological order:
-My mom after 1 month of gas vitrectomy, saw some 2 dark irregular pieces which she thought/described at that time as if the gas bubble has broken into 2 smaller bubbles which are stuck around the eyelid area.This was something unusual since bubble doesnt travel to that position in eye normally. Our mistake was that instead of taking immediate action, we waited and assumed maybe its the way bubble breaks..since the eyesight was not yet affected.

-After 2-3 days the whole gas spread infront of her eye like dense cloud!!

So thats what happened! Thats when we immedaitely went to doc and he conducted tests and OCT showed the hole had re-opened.

So, I know you are rightly worried. Doc also couldnt really justify why it happened! But everything else in her eye was normal.
Btw can you explain when you said gas cant go through a hole? I mean with what I know, gas can! Why cant it? I mean its gas, just like liquids it can also go through -though maybe with not the same speed/rate/frequency etc.
And since it was 1 month post-op my mom wasn't posturing at all. And the spreading of gas like a dense cloud hints on gas going through the hole. Thats what doc could deduce. Though you're right when you say its very unsual..since I hardly found any such case over the internet.

The real question however was that why the hole opened that too after 1 month post-op?! Doc was surprised with that.
But to tell you the truth, my mom with a history of one successful gas vitrectomy in the other eye took this surgery very lightly. She didnt posture strictly, not even in the first 15 days. And probably exerted with the house chores and went out for shopping too (that happened after first 15 days. She 62 ). So maybe thats the only reason doc could come up with for the hole reopening since it didnt maybe heal properly...
And I did find some research papers claiming around 5-10 % chances of holes reopening and then retinal tear/detachment complication is probable aswell. And well its all luck I guess...

And then about the hair braid like thing...my mom initially said its one of those 2 irregular things she saw before this whole complication arose, but later on she wasnt sure since this seemed more irregualr( kind of broken) from one end. Also, its not frail and totally thread like, its rather like a long mulberry . So then in last post-op checkup she specially asked doc to see what it is and he confirmed its 'air'/bubble that had remained. My mom also confirmed that she was aware during the silicon surgery when the doc sucked one of the 'two' bubble pieces around her eye lid, so maybe one remained!
Anyway, I am still not sure especially after reading your posts as to what those 2 irregular things were and whats this one braid/mulberry like thing that remains!

In my thinking: those 2 things (sorry for the vague terms could be: 1) some floater one sees before a retinal tear. 2) Actually some stray, smaller broken bubbles

But this hair braid thing she sees NOW could be: 1) the gas bubble which was not sucked away properly 2) some piece of vitreous fibre that remained as you pointed out 3) OR , I didnt mention before, my mom had laser treatment- thrice till now. One was at the time of silicon surgery to seal the tear so maybe this braid like thing is some retinal wall residue that breaks when it gets treated with laser...I read something like it happening.

Also, like I added previously she sees some small blackish specks throughout the silicon oil which probably are the RBCs.

So yeah I hope it makes some sense now...
And frankly, as the doc mentioned, theres nothing that can be done about that braid thing for now. I pray and hope it doesnt harm in any way ..and as doc said it can be removed only when he will remove the silicon oil. So for now praying and trying our best to be careful till the silicon gets removed.

 
Reply With Quote
Old 04-14-2013, 12:02 PM   #14
Junior Member
(female)
 
Join Date: Apr 2013
Posts: 10
Er245 HB User
Re: Vitrectomy- silicon oil

An briefly about the wavy vision, hers is a slight curving of the vertical lines like a curvy kink (not sharp but smooth). Thats how she describes it but probably I am not describing it well or understood it well. We are waiting for the next visit to bring up that issue again.
Amsler grid, with what little I know of after research, has different distortion pattern for ARMD and so I am still thinking the wavy vision is due to retinal tear.
I'll research more when I'll get time about it. Or probably the doc will tell somethin more. I'll kjeep you posted

 
Reply With Quote
Old 04-14-2013, 01:12 PM   #15
Member
(male)
 
vitcat2's Avatar
 
Join Date: Jan 2013
Location: Seattle, WA, USA
Posts: 87
vitcat2 HB Uservitcat2 HB User
Re: Vitrectomy- silicon oil

Thanks for your detailed responses.

With regards to the "gas" going through the retinal tear/hole, of course, you are right, it can but the scenario I was assuming was slightly different: first, pre-vit op, normal eye liquid/no air-bubble, then retinal tear, then liquid goes behind the retina and peels it leading to retinal detachment; then, vitrectomy op, laser treatment to seal the tear, and then the air bubble is ingested - so, "if the retinal tear is properly sealed," the air/gas bubble usually cannot go through it; the natural eye fluid, if any, also cannot go through it [but air/gas is preferred over the liquid to be near the macular seal ("face down" position) beacuse of another reason - if, instead, that air bubble is on the opposite side, near the lens, (as with "face up" position), then it can accelerate the formation of cataracts in that lens, and you don't want that]. So, only if the seal is not proper, when the air bubble exists, and opens up, (which you found is very rare, but can happen), then, yes, as you say, it may be able to go behind the retina and detach it - if a difference in pressure existed across the retinal surface. I was assuming the seal was not broken. Perhaps, the viscous properties of the liquid (surface tension), as opposed to air/gas, may also be playing a role in peeling/not peeling. You and the doctor may be on the right track that it must be the re-opening of the tear(s) or hole, due to whatever, that caused RD leading to a second vit sx with silicone oil. A retinal research worker should be able to throw some light on the root-cause of such re-openings. By the way, sometimes the surgeon uses "cryopexy," in addition to "laser retinopexy," for sealing retinal/macular tears (cryo = very cold, laser = very hot), as they did in my case. But, I don't know how they differ in terms of sealing/scarring/healing properties.

Regardless of the reasons, which, we, including the doctors, frankly, may or may not understand completely, I hope your mom starts seeing better and better as time goes by and the eye heels by itself.

Last edited by vitcat2; 04-14-2013 at 01:13 PM.

 
Reply With Quote
Reply Reply




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added








TOP THANKED CONTRIBUTORS



JodieJ (11), tubint (11), senior41 (8), Laura1000 (8), TopGeek (8), Bleue (8), earthworm88 (7), Eagle (7), esker (7), dhurlbert3 (5)

Site Wide Totals

teteri66 (1136), MSJayhawk (941), Apollo123 (856), janewhite1 (823), Titchou (771), Gabriel (743), ladybud (667), sammy64 (666), midwest1 (655), BlueSkies14 (610)



All times are GMT -7. The time now is 09:44 PM.



Site owned and operated by HealthBoards.com™
Copyright and Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!