Vitrectomy Eye Surgery for Macular Pucker

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Vitrectomy Eye Surgery for Macular Pucker

I produced my first patient education video! It is video of me performing a vitrectomy to remove an epiretinal membrane. Enjoy!

This is my first patient education video.  I uploaded this last evening to YouTube.  It is one of the best I’ve seen for a super niche like eye surgery.

Vitrectomy Surgery

As I state in the video, vitrectomy surgery is performed by retina specialists.  I completed extra training to specialize and to perform retinal surgery.

A vitrectomy is the core operation for many of the surgical diseases we treat.  For instance, a vitrectomy is used to remove an epiretinal membrane (ERM), fix a macular hole or repair a retinal detachment.  A vitrectomy can remove floaters.

It is very similar to arthroscopic surgery or laparoscopic surgery in that all the systems are “closed.”

Patient is Awake and Comfortable

Most of my procedures are performed while the patient is awake.  Before surgery, the patient receives a sedative, putting them to sleep for a few minutes while the entire eye is numbed.

This “IV sedation” or “twilight” form of anesthesia is quite popular in most outpatient surgical settings.  It avoids the rigors of general anesthesia.

By the way, the operation is completely painless!  I am usually able to talk to my patients while operating.

25 Gauge Instrumentation:  No Stitches!

The instruments used have revolutionized vitrectomy surgery.  The instruments are so thin, that we no longer have to take time to stitch the eye.  This improves efficiency (shortens operating times), but also causes less tissue damage and greatly speeds up healing time (fewer office visits).

What Does This Mean?

You’ve probably noticed that you see more and more video.  It’s a great medium, it captures your attention via audio and video, the costs of equipment are miniscule and the video quality is exeptional.

I produced this entire video at home using iMovie (Apple).  The operation took about 16 minutes in real time.  Many thanks to Meredith Maclauchlan for her skill in adding the special effects and background!

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Comments
  • Judith Nicotra July 12, 2011 at 12:28 pm

    Randy

    Congratulations on incorporating technology to bring your patients and colleagues and even better understanding of what your skill and expertise can do to improve patient care and demystify what happens in the OR. Tremendous!

  • Elizabeth Sachs July 12, 2011 at 3:10 pm

    Dr. Wong,
    All I can say is WOW!! That is so cool.

  • John D. July 12, 2011 at 11:26 pm

    So this is similar to what you’ll do to me if/when you perform a floater only vitrectomy? Cool.

    Would I be completely asleep or just for a few momentous? If not, will I be able to see the needles coming in and out?

  • teresa weber July 13, 2011 at 10:48 am

    Congrats! Amazing video – you are spectacularly skilled, Randy – also, nice background music and commentary. Kudos!

  • Bailey S July 14, 2011 at 1:17 pm

    Great video! I just had this done about three weeks ago-except mine was a 23g vitrectomy. I don’t think my membrane came off that easy. My surgeon said mine was well adhered. I could see him pulling the membrane off during the surgery-kind of neat to watch. I am glad it is over and I am waiting patiently to see how my vision ends up. Keep up the great work on your blog.

  • Monterey Park Optometry July 19, 2011 at 3:24 pm

    Dr. Wong,

    This is a great service that you provide. A video definitely not for the squeamish!

    Best,
    Monterey Park Optometry

    • Randall V. Wong, M.D. July 22, 2011 at 7:27 am

      Dear MPO,

      I am quite proud of the video. It is a little “lighter” than most. The resolution is impressive and speaks volumes about how far technology has become. I remember my first computer had a “green screen.”

      Thanks for the comments! I am hopeful to get a few more up this summer.

      Randy

  • John D. July 22, 2011 at 11:34 am

    I am personally interested in a vitrectomy for floaters only. Not sure how different it would be from the above video though, perhaps the difference is not warranted?

    A video for The sterilization process before eye surgery may not be very “exciting” but can be very informative to patients before they go in and what to expect. To date there are very few to none showcasing pre-operative procedures.

  • Ann Guidera August 6, 2011 at 4:07 pm

    Dr. Wong,
    I also thank you for the wonderful video. I have a fold in my macular and wanted to know the procedure for surgery . Being a person who has had more than my share of surgeries including quad by-pass, and many more starting at the age of 7 weeks nothing scares me at all. I just prefer to know the procedures regarding the eye surgery, I live in Arizona. I have an appointment with the eye surgeon this coming week .Now I can ask him what procedure he uses. Once again thank you so very much. You have eased my mind a great deal. I appreciated your video very much
    Sincerely,
    Mrs. Ann Guidera

    • Randall V. Wong, M.D. August 7, 2011 at 10:39 am

      Dear Mrs. Guidera,

      Dear Mrs. Guidera,

      You are welcome. I hope it wasn’t too gruesome, but I am very happy with how we “produced” the video.

      The surgery should not be too scarey for you now!

      All the best to you.

      Randy

  • Patrick Dwight September 14, 2011 at 1:52 pm

    i have been diagnosed w/a macular pucker in my right eye. This was noted after I had cataract surgery in the eye. I was told yesterday that the pucker is inflamed and am taking drops to relieve the situation. I was told that additional procedures may be necessary. I had detached retinas in both eyes years ago. I had follow-up surgery to release the pressure caused by the buckles. When this was done, my lateral rectus muscle was “trapped” under the buckle and a few years later I developed double vision. I had surgery to reposition this muscle so I could see straight ahead w/o double vision, but over the years it has returned. I don’t use my right eye as much due to this condition. My left eye is my dominate eye. I need cataract surgery for my left eye, but am concerned that I may experience the macular pucker in this eye just as I did in the right eye. Your video was quite informative, but I am concerned about having the vitrectomy on either eye because of my previous detached retinas. When I had my strabismus surgery, it was quite painful. It was an “out-patient” procedure as well. So I am concerned as to the pain level of the vitrecomy. Cataract surgery was not a problem for me. Can you offer any advice as to what you would recommend given my particular situation?

    • Randall V. Wong, M.D. September 19, 2011 at 6:23 am

      Dear Patrick,

      The vitrectomy for macular pucker should not be anymore difficult/painful than your cataract surgery. While the video may look gruesome, there is no pain and is performed as an outpatient.

      In contrast is a surgery involving a scleral buckle. This can be rough and uncomfortable or painful.

      I would proceed knowing that there is a chance of detachment (as there is for everyone), yet not worry about pain.

      Randy

  • sue October 23, 2011 at 5:42 pm

    Is it possible to repair a macular pucker and strabismus with one surgery?

    • Randall V. Wong, M.D. October 26, 2011 at 12:36 am

      Dear sue,

      The answer is, technically yes, but practically…no.

      Two different surgical types and it is possible that the pucker is contributing to the strabismus. If so, I’d only want one surgery at a time, perhaps perform the ERM surgery and then readdress the strabismus at a later time?

      Let me know if this makes sense to you.

      r

      r

  • Susan January 7, 2012 at 6:20 pm

    Dr. Wong.
    Thanks for posting your great video and blog. I have been told there is nothing that can be done for my floaters. I have wet macular degeneration in my left eye and dry in the right. The right is the dominant eye: and I have several small floaters which are annoying. However I had a very large one develop, completely blurring my vision. It keeps me from driving during traffic and at night because the left eye has minimal usuable central vision remaining. I am extremely nearsighted (-17 diopters), and age 52. I am concerned about doing anything to put my right eye at risk, but I was wondering if you thought I might be a good candidate for the removal of floaters.

    • Randall V. Wong, M.D. January 9, 2012 at 11:26 am

      Dear Susan,

      Having one functional eye makes your decision pretty tough. Clearly balance the risks of surgery with the difficulty you have on a daily basis. This is a conversation that should take place between you and your surgeon.

      To me, anyone who understands the risks and who clearly has decreased vision from floaters is a good candidate.

      r

  • Kenni André Pedersen January 13, 2012 at 11:31 am

    Hi Dr Wong. I have written to you a couple of times before. I had my second retinal detachment
    surgery on december 27th, because of an increase in subretinal fluid. I had laser, cryo and gas bubble to seal a leakage they couldnt see or find. Intraop they didnt find any new holes but he was positive post-surgery. Now im in for the third time, because of an increase in subretinal fluid, so im scheduled for a possible vitrectomy on monday where they’ll try to locate the leakage intra-op and do a laser cerclage. Im at a point now where i dont know whats best for me and im afraid of PVR because of the many surgeries. Is this usual for a 25 year old to go through. Do you have any experience with this? 🙂

    • Randall V. Wong, M.D. January 19, 2012 at 7:58 pm

      Dear Kenni,

      PVR is not inevitable. If there is a missed tear/hole leading to continued retinal detachment…it must be sealed.

      I hope this time your outcome is better. Hang in there. You might want to get another opinion, too.

      r

  • Kenni André Pedersen January 13, 2012 at 11:34 am

    The smiley face on the end came out wrong.

  • Kenni André Pedersen January 24, 2012 at 6:41 am

    Hi Dr Wong! I just wanted to give you an update on my progress, or lack thereof, after my vitrectomy-surgery last monday. My doctor performed a vitrectomy, and did some laser because she found a small hole (yeah! Hopefully the one we had been looking for) in my nasal region of the retina which had detached a little. She left a little of the vitreous anteriorly to protect the lens against the gas bubble she put in, that filled 90% of the eye. Now a week later it has shrunk to half this size, and i can still see, although a little blurry and foggy. I went for the one week follow up today, where the Dr. unfortunately had some bad news. It seems my luck wont change. In the lower part of the retina, there was too much stretching, which she believed was caused by scarring. So she feared another detachment might be coming on in that part. I was hoping for good news, and received the opposite today, so im quite morally weak right now. But we decided that I should be monitored closely, and that i was to return in a week, and see if the situation had changed or do a relaxing retinectomy, which i would very much like to avoid, since i’ve been through 3 surgeries already, and im fearing that neither me or my eye can cope with yet another surgery and recovery-time. Im beginning to loose faith in my doctors, since i presented ca. 3 months ago with good vision, with a slight shadow in the periphery and a chronic macula on detachment, and I now have had 3 surgeries, and im still not stable in the eye. Do you have any input on this Dr.? Should i seek help elsewhere? Here in Norway we have a different healthcare service than you do in the US. There is 1 major university hospital here that does 80% of all eye surgeries in the country, and its free unlike the healthcare in the U.S. So its not so easy to just seek help another place. Im sorry for asking you this much questions but you are the only dr., as far as i now, that can provide free answers on the web. 😉

    • Randall V. Wong, M.D. February 1, 2012 at 11:39 am

      This is a tough question.

      In the U.S., we might certainly recommend a second opinion.

      On the other hand, be mindful that retinal detachments are sometimes not “fixable” as PVR can develop occasionally. There is no great therapy for PVR, but I recommend early intervention once diagnosed.

      That is to say, given your situation, you might go through great expense simply to find that everything has been done appropriately and your disease is winning.

      Randy

  • Kenni André Pedersen February 21, 2012 at 11:13 am

    Hi Dr. Thanks for your reply on the former question. The situation has now changed and im 5 weeks after my 3rd surgery, and I don’t need another one right now after the vitrectomy I had last. I went for a second opinion at a private clinic, and they just told me to trust the surgeons at the university hospital, cause they were good at their jobs. When i went up to the hospital after the last post here on your forum, i was expecting a retinectomy-surgery as i told you about, but the dr. surprised me and told me we should cool down a bit and see if my low lying retinal detachment wouldnt fix itself. I have some thick subretinal fluid under my retina that seems to be persistent, but she said that if we gave it enough time it might fix itself, because no holes or tears were present now, and since my vitreous was removed no traction was possible either, so now im suddenly hanging on to hope, and has begun living a normal life again, excercising and working.

    The only symptoms i have are those i’ve always had and thats a shadow in the left periphery/central (near papilla) when its dark in the room, probably the most light sensitive rods/cones that are struggling with the subretinal fluid, and metamorphopsia in the left part of my eye. Like seeing through water there. But im still enjoying good central vision with no problem, so right now im happy and praying that it stays that way. Im going back to my surgeon on tuesday next week for my 6 week follow-up, so i am a little nervous and a little excited.

    Cheers

  • Herb Korn February 23, 2012 at 1:49 pm

    Dr. I had a vitrectomy for a macular pucker 10 weeks ago. The result was that there was no improvement and I have developed diplopia in the operated eye. Any suggestions?
    Thanks,
    Herb

    • Randall V. Wong, M.D. February 24, 2012 at 9:51 pm

      Dear Herb,

      In most cases you should notice some change….occasionally it can take months. I wonder if there is something else going on in addition to the ERM?

      Randy

  • Kenni André Pedersen March 7, 2012 at 7:42 am

    Hi Dr. Wong! I just wanted to update you on my situation. I went to my doctor again for my 6 week checkup, and she meant that the subretinal fluid had decreased but the retina wasn’t completely reattached yet, but she still wouldn’t do surgery because she wanted to wait and see if it resolved itself. Because of my chronicity the fluid is very thick and hard to absorb and it could take many months. I have a pretty severe cataract forming now, that is to be operated on when my eye is stable. All in all this could have turned out much worse and im happy about the situation and hoping it will resolve itself in time.

    I had a question about vitrectomy though. Im under the belief that a vitrectomy will actually negate my risk of developing a new retinal detachment since it cant pull on my retina no more, and make traction or new holes. Is that true? Will the risk of me getting a new detachment there be less than normal, or is it just my impression? I understand that the inside is more watery and thus can run behind the retina a lot faster but, then you need a new hole right?! 🙂

    Thanks Dr. Wong. You’ve been a great help in this period of my life.

    Cheers!

    • Randall V. Wong, M.D. March 7, 2012 at 8:05 pm

      Dear Kenni,

      Good news.

      Yes. You are correct, at least in theory….if the vitreous were removed, nothing can pull on the retina and cause a tear. There may be some extreme and unusual exceptions, but I agree with you.

      There is also the possibility of the operation, itself, causing a tear….probably about 1%.

      Good luck. Glad you are still “healing.”

      Randy

  • Kenni André Pedersen March 28, 2012 at 9:28 am

    Hi Randy! My luck didn’t last unfortunately. I was at my 2 month check up yesterday, and there seems to have developed some PVR in the bottom of the retina. My doctor says it looks like the retina is contracting there and that makes it difficult to settle. Its sad since I was in such a good drive now, with work and excercising, and with the thought that it might take care of itself. :-/ She didn’t say what grade it was or if it was substantial, but the reason might be all the cryotherapy i have gotten. I think i must have 7-9 cryoscars around my retina, and laserburns. Im going to come back after Easter, and have my cataract removed before we see if we are going through with more retina surgery.

    I was just wondering. Can PVR dissappear by itself if its stabilized without surgery, or is surgery always necessary? I still have my Macula on, and im so afraid of losing my central sight, which is excellent right now. Im afraid I have some difficult weeks ahead of me now.

    I hope all your pasients are okay Dr, and I hope i will see some positive development before Easter.

    Cheers!

    • Randall V. Wong, M.D. March 30, 2012 at 8:44 am

      Kenni,

      Thank goodness for the macular attachment!

      PVR does burn out but usually not before detaching the retina. In other words, I would say that surgery is almost always needed, but at some point the process will stop. My best “guess” is that it burns out after a couple months. Remember, we don’t really know what triggers PVR in some people and not the others. My comments are based on my own experience. For instance, if you have a retinal detachment, PVR usually strikes within the first few weeks after surgery and not “randomly” months or years later….just my observations.

      If your macula is on, make sure to see your doc (if you can) if you notice any change in your central vision. I know our medical systems are different, but you central vision is in jeopardy.

      r

  • Kenni André Pedersen March 30, 2012 at 9:09 am

    Yeah, thank god for that! Its not that i have to have surgery again that has me twitching but, the wait, for that surgery. Do you believe i should have had surgery immideatly after my last consultation, or do you think my dr. conservativity is a good thing in this situation?

    I can’t seem to catch a break with this, but i’m ready to do what it takes. Its just that all the talk of membrane peeling, recurrent detachments and retinectomies that scares me a little. I started with a small, but chronic detachment, above my nasal region that was fixed with cryo and the buckle, and now im 3 surgeries down the road, and i still cant seem to be done with this and move on with my life.

    Thank you for your speedy reply dr.

    And have a great easter holiday! 🙂

  • Kenni André Pedersen April 19, 2012 at 5:35 am

    Hi Dr Wong! I just wanted to update you on my situation as promised. I have now had my 4th surgery. This time my surgeon removed my cataract, and did a vitrectomy in the same operation. I had a shallow detachment in the lower part of my retina which she treated with laser. I have now had quite a substantial amount of laser treatment throughout my surgeries, and she told me afterwards that it almost goes around 360 degrees. To think that i came in with a shallow but longstanding detachment in my upper right quadrant, and now almost have a 360 degrees lasered retina. That for me seems a little over the top.

    But im still hoping that the retina will flatten this time, and that it stays in place. At the moment i cant see too much because of a little blood in my vitreous but she said it would settle in the next coming days. With this i hope i can now live my life as normal again, in a few weeks time. If I have to have surgery again, i dont think i want to. I just want to be free of this problem.

    🙂

    • Randall V. Wong, M.D. April 21, 2012 at 8:04 am

      Dear Kenni,

      Hang in there! I, too, hope this is the end for you!

      Believe it or not, it’s tough on your doc, too, when you redetach.

      Thanks for the update.

      r

  • Kenni André Pedersen April 23, 2012 at 5:33 am

    Yes! Thank you Dr. I will try too hang in there. Its just hard when you see how a presumably easy fix is now complicated with 4 surgeries, and you just walk around with the anxiety that the Dr’s will ruin the retina before its fixed.. :-/

    But thanks.. 🙂

  • Charles Bevitt May 4, 2012 at 5:14 pm

    I recently had surgery to reattach a partially detached retina. Overall, the result was excellent – I have all my field of vision and the visual resolutio is just about at 20/20. The only problem is light scarring on the macula and a macula pucker causing distortion.

    Horizontally, objects appear to that eye to be about 75% of the size they appear to be in my unaffected eye. Vertically, they appear to be about the same size. Also, horizontal lines appear wavey.

    For the first two months after surgery, I patched that eye. Now I’ve had the patch off for a month to see how well my brain can synch up the vision from the two eyes. I’ve had some success in getting use to it, but there are many situations (night driving, far distance, reading, seeing fine detail) where I might function better by using the unaffected eye alone.

    My question is: when an eye with a macular pucker still has execellent resolution, at what point is surgery justified based on the distortion alone? Are there any standards for this, and are there tests to measure distortion as opposed to resolution (I’m beginning to HATE the standard eye chart – I’m told I can read 20/20, so what’s my problem?).

    Appreciate whatever comments you’d care to share.

    • Randall V. Wong, M.D. May 13, 2012 at 1:28 pm

      Dear Charles,

      My opinion is that as long as you (the patient) notice some change in vision, defined as either decreased vision and/or distortion, then you should consider removing the macular pucker. I don’t believe that you should wait to a certain drop of vision (e.g. 20/40) as 1) you can’t measure distortion and 2) noone can guarantee that your vision will return despite successful surgery.

      I operate as soon as a patient notices a change regardless of how well he/she reads the chart.

      Make sense?

      r

  • Cheryl June 10, 2012 at 6:23 pm

    I have floaters in both eyes since October 2011. I’ve been to a number of opthamologist since that time and the floaters have gotten worse. It is as if I am looking through a plastic sheet sometimes crinkled up when I move my eyes. Also cobwebs and rotations when I move my eyes. My eyes feel aching and dry, at times like being squeezed from the back. It is to hard to deal with and I want to know if a vitreous surgical removal is possible. I am 54. Only needed reading glasses up until April, now I need distance also .75. Please help.

    • Randall V. Wong, M.D. June 18, 2012 at 9:52 am

      Dear Cheryl,

      Yes, vitreous surgery is possible with regard to the floaters. The cobwebs and debris moving “to and fro” with eye movement are certainly the “floaters.”

      The aching and dryness, however, are not related to the floaters. In fact, dryness can cause significant blurring of vision.

      I’d recommend getting evaluated for the dryness/aching, fix that problem and then reassess with regard to the floaters.

      Stay in touch.

      Randy

  • Cheryl June 10, 2012 at 6:24 pm

    Anyone can email me with their surgery results. i would be welcome to hear about.

  • Walt Miller June 18, 2012 at 12:16 pm

    Dear Dr Wong,
    I began noticing a decrease in my right eye’s central vision about six months ago. My ophthalmologist said a cataract is developing in that eye and she also suspected a macular pucker. She sent me to a retina specialist who confirmed the manual pucker and asked me to return in four months for a reevaluation. I’ve just had the reevaluation and the retina specialist said my vision has decreased from 20/40 to 20/60. Based on that and the cataract, he wants to arrange for cataract removal and then immediately afterwards wants to perform a vitrectomy and remove the epiretinal membrane. I am extremely nervous about the surgery. I do not feel that the decreased central vision of my right eye is severe nough to warrant surgery as my left eye takes over nicely and is corrected o 20/25 with glasses. I would like your opinion on whether I should proceed with the surgery. i should also add that I am an insulin-dependent diabetic for the past ten years. Please help m decide the best course of action. Thank you.

    • Randall V. Wong, M.D. June 26, 2012 at 9:01 am

      Dear Walt,

      Cataracts: usually causes gradual decrease in vision. In my opinion, cataracts can basically wait until you (the patient) feel that surgery is needed. The degree of cataract at the time of surgery does not impact your visual prognosis.

      Macular Pucker: this is NOT the same case as cataracts. Once you notice a change in your vision (macular pucker can cause decreased vision and/or distortion) I would encourage surgery because noone can guarantee how much vision lost from the pucker will be regained, that is, I recommend removing ERM’s as soon as they cause symptoms.

      Cataracts and Puckers at the same time: I recommend, to my patients with both cataract and ERM’s;

      Cataract surgery first; this may be all that you need, that is, after cataract surgery, your vision may be improved enough so that ERM removal is not necessary….or at least not yet. Cataract surgery may also enhance my view so that removal of the ERM is easiest and, last, cataract surgery before ERM surgery reduces the chances of recurrence of the ERM.

      Thanks for writing and I hope I didn’t make you more confused!

      Randy

  • cheryl July 18, 2012 at 12:55 pm

    Dear Dr. Wong,

    Is it better to get cataract surgery with an FOV even if you don’t need cataract surgery? What I have heard once you have an FOV you will most likely need cataract surgery down the road. I am 54 and was 20/20 but now need distance glasses of .75 since May 2012. I also used reading glasses. My floaters are not dark, but move in a mistiness, like looking through a piece of glass..cloudy glass. I see a crystal worm in left eye that moves and changes directions, big and small. Right eye has floaters that are clear, circular that I can see, but they are also not dark. Although it also depends on the lighting conditions, inside a house with lots of windows it seems cloudy. Outside is clear, but like looking through a piece of glass. Many times I also see after images of things. The light intensity is getting less.
    There is much anxiety over this and I am taking Xanex for it. Can you help explain the many different types of floaters that people see..those who you have worked on. Are most FOV successful with a very good Doctor.
    Thanks so much.
    Cheryl

  • cheryl July 25, 2012 at 4:00 pm

    Does anyone use 27 gauge instruments in the United States? How new is this and is it better than the 23 and 25 gauge. Do you use a B Scan to see the floaters and also see if there is vitreous detachments in the eyes. What other test do you do to make sure the eye is healthy to move forward on an FOV surgery.

    My floaters are like looking through vasaline/cloudiness. I had an B scan and the vitreous is still attached, but you can see the floaters in the center floating around. Once the vitreous is removed is it just as easy to do a cataract surgery down the road? Are complications rare…as long as you have an excellent surgeon.

    • Randall V. Wong, M.D. July 31, 2012 at 11:18 am

      Cheryl,

      1. Yes, 27 gauge is available, but I don’t believe it offers any advantages above 25 gauge. 23 gauge is not used as often as 25 gauge and also offers few advantages over 25 gauge other than being a tad bit quicker.

      2. I don’t use a B-Scan. It is a worthless endeavor for the doctor to try and visualize the same floaters seen by the patient.

      3. I usually don’t recommend other tests. Most problems can be determined by a thorough exam, not using every test available.

      4. Cataract surgery should be no problem following a vitrectomy.

      5. Complications are unusual.

      Randy

  • cheryl August 1, 2012 at 2:17 pm

    HI Doctor Randy,

    Thank you for responding. The other questions I have regarding a vitrectomy and exams are the following;
    Upon examination of the eye through dilation and the Doctor see the floaters that a patient see’s?

    Can the Doctor see through the examination if a patient has a PVD or partial PVD?

    Is it better and easier to have a vitrectomy with a natural PVD or even a partial compared to one that has to be induced?

    Is it better to leave some of the vitreous behind the lens during the vitrectomy?

    Where should the eye pressure be before and after surgery? Does the eye pressure return to normal quickly?

    What type of medication is required after the surgery? How long is one required to stay on medication?

    What is the amount of time between doing one eye and than the other eye?

    Thank you for answering my questions.

    Sincerely,
    Cheryl

  • Jen August 5, 2012 at 10:51 pm

    Dear DR Wong, I have had 3 surgeries for detached retina and am now returning for oil removal,vitectomy,laser again and a peel of membrane. I am anxious to hear what your thoughts are on how the oil removal is compared to vitrectomy and sceral buckle surgery. Also, does the complicated detachment patient ever see the light at the end of the tunnel? I have been super positive and doing all that I am suppose to do as far as drops and positioning. Have not slept on my back since December, just wondering if this usually settles down after a period of time? My surgery is scheduled for this Wed am. Thanks so much!

    • Randall V. Wong, M.D. August 17, 2012 at 9:42 am

      Dear Jen,

      I hope your surgery went well. I apologize for the delay in responding. I have been away.

      Oil removal is a tedious process. Basically one flushes out the oil through a very tiny hole. It can take anywhere from 15-30 minutes depending upon the viscosity of the oil and the gauge (size) of the hole. Unlike retinal detachment surgery with a scleral buckle, tissue manipulation is minimal, so discomfort/recovery should be minimized.

      Retinal detachment surgery can be all consuming as you are experiencing. As I have become more experienced (fancy word for older) I have realized that much can be gained by using silicone oil early in the redetachment process.

      I hope you are doing well. There is a light at the end of the tunnel.

      r

  • Rick September 20, 2012 at 6:38 pm

    Dr Wong:
    I have had retinal tears and 2 lasers/cryo in my ‘good’ eye. It also has a cataract that we were monitoring prior to retinal tears. In other eye, had 3 laser/cryo procedures and then the buckle – all in approx 6 wks. I now have a pucker and substantial floaters in the buckle eye, with much distortion such that the eye is not of much value. I must soon make a decision about vitrectomy. What information is available to help with this decision as far as success rates, etc.? Thanks.

    • Randall V. Wong, M.D. September 26, 2012 at 9:54 am

      Dear Rick,

      Success rates vary with ERM surgery. In my opinion, “vision success” is dependent upon the timeliness of the operation. Most surgeons wait too long before offering the surgery.

      I recommend operating the ERM as soon as you notice a change in your vision (either decreased and/or distortion) and your surgeon agrees. If she doesn’t, get another opinion.

      The reason…noone can guarantee full restoration of vision with ERM surgery once the membrane is removed.

      In most cases, the ERM should be removed easily.

      r

  • Larry Parker September 21, 2012 at 10:19 pm

    Hello Dr. Wong,

    I had Lasik surgery about 7 years ago and have developed noticeable floaters in recent years. I’m attributing this to being very near-sighted and having the lasik performed. I wore glasses and contacts for more than 30 years so, it was a real miracle for me. Now however, I find almost daily frustration in dealing with these floaters. My left eye is particularly bad, like having a smudge in my field of view. I’ve consulted with specialists over the last two years (annual visits) and both have stated that a vitrectomy is very dangerous and should be considered only as a last resort. I’m curious if you agree and do you know and could recommend anyone in the South Florida (West Palm Beach) area with whom I could consult? Thank you.

    Larry

    • Randall V. Wong, M.D. September 25, 2012 at 9:44 pm

      Dear Larry,

      The Lasik has nothing to do with your present floaters. Perhaps the fact that you are naturally near-sighted may impact the chance of having annoying floaters.

      Regardless, the facts are that vitrectomy is actually safer, or as safe, as cataract surgery. Blinding infection rates (called endophthalmitis) are lower with retina surgery compared to cataract surgery. The chance of retinal detachment with vitrectomy is comparable to cataract surgery, too.

      Don’t know of anyone in FL…sorry.

      So, I don’t agree it’s dangerous and can be performed as long as you agree and understand the risks I stated above.

      I wish you all the best!

      Randy

  • Patrick November 29, 2012 at 2:52 pm

    Dr. Wong, thank you for your very informative website. I’ve undergone a number of retinal repairs over the past year and a half and am now trying to more fully understand all that has happened. I’m curious as to what fluid is used to replace the vitreous during a vitrectomy (assuming it’s not silicone oil.) Is it a simple saline solution? Does it remain in the eye or is it absorbed and replaced by the body with a natural vitreous? Thank you in advance for taking the time to answer my questions.

    • Randall V. Wong, M.D. December 7, 2012 at 6:31 am

      Dear Patrick,

      You are correct.

      The vitreous is mostly water. I think it’s about 94% water mixed with protein. When removed, it is replaced with artificial saline which is then absorbed and replaced by aqueous (basically your own saline) within 48 hours.

      r

  • dave December 7, 2012 at 4:01 pm

    Dr. Wong. I was diagnosed with a macular pucker on 12/ 3 from a scleral buckle surgery on 9/13. I am definitely considering a vitrectomy because my vision is now very poor. Is there a timeframe I should be considering? My doctor said the vision is not going to get worse and there is not a rush to decide on when or if to get the surgery. Your thoughts would be greatly appreciated. Thanks

    • Randall V. Wong, M.D. December 12, 2012 at 8:27 am

      Dear Dave,

      I advocate removing the ERM as soon as you (the patient) is aware of vision loss. If the vision loss is mild (mild blurring +/- barely noticeable distortion), perhaps you can sit on it for a while. The reason I advocate operating as soon as you become aware is that noone can guarantee complete restoration of vision with ERM surgery… the earlier the better.

      Be careful; however, your doc may not feel the same way I do.

      Best of luck.

      Randy

  • dave December 17, 2012 at 9:23 am

    Thank you Dr. Wong. Your website is very informative. My Dr. recommended we wait a few more weeks because I may still be producing scar tissue from the original surgery.

  • dave January 30, 2013 at 3:11 pm

    Hello Dr. Wong. I know there are no guarantees but what is a realistic timeframe to see an improvement in distorted vision following a vitrectomy? My doctor has said that the retina is attached and lying flat. However, there was a fold in it at one time. Thanks.

    • Randall V. Wong, M.D. February 2, 2013 at 5:13 am

      Dear Dave,
      If the macula was involved, it could be six months to a year. A realistic timeframe would be within 3 months…this is just a generalization.

      r

  • maribel whalen January 31, 2013 at 2:49 pm

    I am desperate to find a surgeon who will remove scar tissue on the inside of my eyelids. It’s from calcium deposits that were scapeled off that are now irritating my cornea.
    I am so frustrated because I can’t find a specialist or anyone who will even take care of the problem for me. Thank you if you can refer someone to me. I live in Sarasota, FL.

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