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vitcat2 02-01-2013 01:44 AM

Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
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 [B]vision distortions[/B], whence, this post:
(i) image is slightly [I]smaller [/I] and [I]displaced [/I] (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 [I]double vision [/I]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.

vitcat2 02-03-2013 03:58 PM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
I got answer to my last question from my doctor yesterday: if you already have had cataracts operation, with an artificial lens (IOL) replacing the natural lens, then there is no possibility of cataracts after vitrectomy, although that's one of the most probable thing that happens to most patients without previous cataracts and IOL. That is also the reason, I think, most probably, for a much shorter period of face-down period (only 36 hours) for me (this is my own observation, not my doctor's) - since one of the reasons for face down, I have read, is that the air bubble is kept away from the lens where it can accelerate the formation of cataracts in a natural lens. But one needs the face down position any way to press the macular detachment I had back to the base (RPE) and keep the fluid away from the sealed tear.

Budjd 02-04-2013 07:39 AM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
I recently have had surgery this past fall and in January. I am left with right eye having distortions (Sx-9/2012) and left eye (Sx-11/2012 & 1/2013) distrtions with grey image across my vision. How long does it take to heal? Will my vision ever return to previous vision? Can I work all day on a computer and drive to various locations for work? I guess I'm as anxious as you, and can't wait to get back to normal.
What is your docotr telling you?
I, too have had 3 vitrectomy surgeries due to macular hole in both eyes. The first in my right eye, in September 2012; and my vision is "OK". Still have slight distortions, and hoping this returns to normal. Previosuly just needed glasses for distance...driving, movies.
In Novemeber had vitrectomy in left eye...hole never closed and was left with a gray image across my vision as weel as distortion. Because my doctor had no bedside manner and was not successful, offering poor alternative suggestions.
So in January 2013 another surgeon perforemd the second Left eye vitrectomy. Different from the first two surgeries this gas bubble inserted was larger, serum from my own blood was dropped in my eye during surgery. Results was the hole sealed, bubble was gone in 11 days. The new doctor is very concerned, professional, but says it's still early to predicted how my vision will be.

vitcat2 02-06-2013 05:14 PM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
Hi Budjd,

Thanks for your input and q's. The bottom line is that "Just hang on there, there is a lot of hope in improving even macular detachment, and the dr says the brain-eye coordination will improve with time so far as visual distortions (size, shift, waviness, wigliness) are concerned. With macular detachment in both eyes as in your case, however, it may take longer to adjust to the new vision."

xx1944 02-06-2013 07:33 PM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
vitcat did you have the vitrectomy because you had floaters or did you have a tear first??
The vitreous has to be removed to do any retina work. Did you get floaters after cataract
surgery?? very common.
btw were you totally knocked out for the procedure?? what state did you have it in??

vitcat2 02-06-2013 11:10 PM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
1. The sequence of events for the left eye with respect to the vitrectomy operation was: retinal thinning (or, lattice degenration, 12-13 or more years ago), cataracts (11 years ago), no floaters after cataracts, preventative 360-deg laser retinopexy (2 months ago), floaters (3 weeks ago), dr said "vitreous separation from retina" is complete without any retinal tears (2.5 weeks ago), lots of floaters (4-5 days ago), retinal tears (as described in the main post) and retinal detachment including the macular hole (1 day), vitrectomy surgery. 3 weeks later vision was 20/50 but distorted somewhat.

2. It was local anesthesia. I was given some medicine via IV for calming me down before the operation and oxygen through the nose; then they said I would be completely out for 2-3 minutes when the dr gives some injection to the eye and after which I found myself being transported to the surgery room. I was fully awake and aware during the operation, my other eye was open and I could see everything if I wanted to, but chose not to for most of the time while the doctor was chatting with his assistants. I could sometimes feel only slight pinches here and there inside the eye being operated, but no pain. I was very calm and steady during the whole operation, and it went very well.

xx1944, are you planning to have vitrectomy?

xx1944 02-07-2013 10:58 AM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
I need one for floaters,bad. I will certainly get cataracts after because I already have them!!!
I am getting the cataracts done in the next few weeks. That way the Doc can see better to do the floater/vitrectomy.

vitcat2 02-07-2013 01:08 PM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
Hi xx1944,

From my experience as a patient, cataract surgery itself is much less stressful than vitrectomy, and heals faster (1 week, at most) - you also see the results quickly (everything becomes much clearer: I got back 20/20 vision with the IOL). That too was local anesthesia for me on an out-patient basis - I could hear and see with the other eye everything during the operation; no pain. Vitrectomy, on the other hand, is a pretty delicate operation with long-term healing process (3-6 weeks, may be, longer, and depends on why it is being done). Hopefully, there is several-weeks gap between them if you are going to go through both the operations one after the other.

If cataract surgery is being done before vitrectomy, as in your case, for whatever reasons, then at least the highest risk of cataracts itself happening after vitrectomy is out - that's good! Further, if vitrectomy is being performed later just to remove floaters, and there is no retinal detachment (RD) to repair, then, I believe, the prognosis for your vision recovery should be great - no floaters, no cataracts! Face down position (an irritating posture) is typically required if you have an air bubble replacing your vitreous, after the vitrectomy, but the air bubble is used to hold up your retina if you have retinal detachment. So, if you don't have RD then you may not have an air bubble, and the vitreous may be replaced by saline solution. If there are only retinal tears, then they are repaired by laser retinopexy without vitrectomy, as in my case early on. But I am no doctor, and you should certainly talk to your doctor about all this before the vit. surgery, as there are always the risks of going through vitrectomy, like, the possibility of getting retinal detachment later which is far more serious than cataracts. Also, I hope, you are not doing both eyes together; you just want to see what happens to one eye first, after cataract surgery, so that the other eye is at least operational. May be, you will already feel great with cataract surgery alone, and can live with floaters! After cataract sx for both eyes, I was very happy for almost 11 years, and occasional floaters did not bother me.

All the best with your cat-vit surgeries, and keep us posted about your progress!

Budjd 02-07-2013 02:09 PM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
Hi Vitcat2,
Thanks for your reply. I see my doctor tomorrow, Ill let you know if I earn anything else. My right eye has pain this afternoon...just on the computer a short time..watched a little this too much. Concerned about returning to work.

xx1944 02-07-2013 07:09 PM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
Vitcat thanks for the input..btw what IOL did you select?? I dont want to use the IOL that my Doc uses almost all the time....for various reasons...I am going for a 3 piece
or a 1 piece.....if you had good luck with yours ,I would like to know which one you used.
I am compiling a lot of info on IOLs...none of them is without some issues. thanks again.
And I lived in WA. for almost 30 years!!!

vitcat2 02-07-2013 07:34 PM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
Hi Budjd,

Sorry for my short response earlier. Here are some more details of my operations and post-op conditions which may help you by comparing notes with your situation. First, looks like you are already done with your vitrectomy sx, and are going to the dr now only for follow-ups, and are looking really for the healing times. The healing time and vision recovery depends on the type of retinal detachment (RD). My right eye had "peripheral, shallow, rhegmatogenous RD," 6-7 months ago, and I recovered in about 3 weeks after the operation with 20/20 vision, and was able to drive, work (computers in near-field, seeing presentations from far away, etc.) immediately after that. But it has slight ERM (epi-retinal membrane) which, fortunately, hasn't made my vision distorted or anything like that yet. The right eye, on the other hand, had "macular, bullous, rhegmatogenous RD," (the more serious type of RD), but without ERM, and my vision was 20/50 on the 16th day and had visual distortions. However, due to my dominant right eye with 20/20, I was able to drive on the 19th day and start working on the 21st day. It's been a month now since the operation, and I am doing everything normal now. The visual distortions (waviness/wigliness) haven't really reduced that much, and I wonder if they will ever go away, but my depth of field has increased considerably from a couple of weeks ago. Especially, if I am in my office, where everything is within 5-8 ft of me, it seems just fine and I can work just like before. My dr has suggested exercising by focusing on a pencil tip held at arm's length - to improve depth of field. So, this is my situation with one peripheral RD and the other macular RD. With both macular RD, as in your case, it may take some more time. But at this stage, I would seriously suggest you to take time to heal completey, and not worry about work and driving, etc. Our vision is our wealth!

By the way, I never had any general gray vision that you describe, but when the air bubble was present I used to see, may be, 4-5 times a day and only for 5-6 seconds, a small grayish-yellow fluid blob (size of kernel of corn) in the center of that air bubble pulsating at my heartbeat rate. It used to vanish immediately after I focused on it. I don't know if you saw that, or if anybody else has seen that.

vitcat2 02-07-2013 07:42 PM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
xx1194 - My cataract surgeon gave me only two choices for the IOL - do you want it for good far vision or good near vision? I selected the good far vision for normal driving, TV, etc. I use reading glasses any way for computer, reading, etc. That gave me 20/20 vision in both eyes then, until this macular RD happened.

tubint 02-08-2013 08:28 AM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
I too live in Washington State and went to see the "top" 6 cataract surgeons in the Seattle area last year. I was wondering whom you were seeing for your cataract surgery ? Perhaps I can share some information with you.

vitcat2 02-08-2013 11:21 AM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
tubint - I have read your other posts with interest, and you seem to have a lot of info on vitrectomy, etc. I was hoping you may have answers to some of the questions in my original post, especially, recovery of depth of field and waviness/wiggliness issue after a 'successful' vitrectomy/retinal repair surgery. What has been your experience after such surgeries in terms of vision recovery? It's been a month for me now with the left eye, and the waviness/wiggliness has not decreased much. It's only because of the dominant right eye (20/20) that I can do everything without difficulty right now. But I worry if the ERM in my right eye becomes troublesome in the future, I will have problems again. Thanks for your time.

xx1944 02-08-2013 03:07 PM

Re: Post-Vitrectomy Vision & Possibility of Repeat Retinal Detachment
BudJD How old are you?? Any other serious med issues?? It is incredibly unfortunate but true that
you have to select good Doctors. I would guess that 1 out of 4 eye Docs are really competent. You have to do Serious homework on who you go to. There is SO much garbage out there I am finding.
Like Docs just trying to make surgical fees. Corporations are paying Doctors to push their products and equipment. Unbelievably un ethical. Some states are worse than others. Its hard if you have to stick to Medicare Docs....btw what IOL did your Docs put in??

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