Replies to This Discussion

Permalink Reply by Josh F on February 13, 2012 at 7:14am

Hi Dr Wong,

So happy to see you here! Please everyone, feel free to discuss any of your concerns with Dr Wong, he is one of the few Retina specialists who uses the internet to help clarify questions we might all have. He has been a god send to me personally and has a great way of explaining procedures in a clear and objective but reassuring way. I suggested once he might be of help here on sites like this, that really do need the resource of someone in the medical field. I am glad he took up the challenge... Too much unfiltered info out there. This is a great opportunity to get your concerns and fears discussed out in the open. Knowledge is power guys. Thanks for coming Dr. Wong!

Permalink Reply by pryde on February 13, 2012 at 2:52pm

Dr. Wong,

Thanks for replying to my post. Unfortunately my vitrectomy has not gone well. The procedure has left me with significant cystoid macular edema with resulting 20/400 vision (I had no macular edema before the surgery). 6 weeks of Acular and pred-forte drops with NO response. Last week received a Kenalog injection with NO response so far.

If that’s not enough, I somehow also "developed" a corneal defect in the same eye which is not healing well with a contact bandage.

In short, my vitrectomy has been a disaster. Maybe I am over-reacting but I feel like my R eye is lost. I have been wearing a patch since surgery because the vision is so poor.

Any advice or insight would be greatly appreciated. I am a medical professional (OT) and have extensively researched my eye conditions so feel free to use appropriate medical terminology.

Thank you, Jeff

Permalink Reply by Randall Wong, M.D. on February 13, 2012 at 7:30pm

Wondering about more details of the surgery. Unfortunately, good vision beforehand doesn't always guarantee the postoperative results. Did you have some element of retinal detachment?

Before, during or after the surgery?

r

Permalink Reply by pryde on February 14, 2012 at 1:40pm

No evidence of retinal detachment at all. According to my doc, the procedure was as "simple" as a vitrectomy can get. Just removal of vitreous, membrane peel, small amount of additional endolaser. Also, he used 25g instruments

Before the PPV I had a SMALL amount of NVE that was treated with laser (tight pattern, good coverage) 1 year prior but unfortuntly continued to have persistent bleeds every 2 months or so. My vision was 20/20 otherwise, even when the bleeds cleared up.

Since surgery 7 weeks ago, my vision is like looking through cloudy wax paper with a mild distorted visual field, in other words not functional at all. Obviously, I deeply regret the procedure but am holding onto hope that things will improve somehow.

Anything you can add is very mcuh appreciated. BTW. I am 39, diabetic since 5, great glucose control for most of my life (A1c <5.5), otherwise healthy with no other complications.

Thank you kindly

Permalink Reply by Randall Wong, M.D. on February 14, 2012 at 1:59pm

My thoughts are possibly;

1. Persistent vitreous hemorrhage
2. Recurrent/progressive epiretinal membranes.
3. Cataract

r

Permalink Reply by Randall Wong, M.D. on February 14, 2012 at 3:07pm

One other point.

In general, a vitrectomy with laser, and membrane removal, if needed, is usually a very safe procedure. In my experience, most patient and thier physicians wait too long before considering surgery.

Good/excellent vision, unfortunately, is not a prognostic indicator of outcome, that is, the vision can be great, but the disease is advanced.

Randy

Permalink Reply by pryde on February 14, 2012 at 5:46pm

Thank you Dr. Wong,

Do many of your patients get CME after a vitrectomy? Wouldn't my specialist be able to determine if a cataract, epiretinal membrane, or vitreous hem would be a cause of the poor vision in addition to the CME?

I know it is difficult for you to determine but would you consider my prognosis poor based on what you know?

You must have had at least a "similar" case in all your experience, no?

Permalink Reply by Randall Wong, M.D. on February 15, 2012 at 4:38am

It would be unusual to get CME after a vitrectomy if it weren't there the morning of the vitrectomy.

The literature suggests macular edema may develop after PRP, but it sounds as if your's was limited.

Still thinking...

r

Permalink Reply by pryde on February 15, 2012 at 12:01pm

The literature I have read suggests that CME can develop after any type of eye surgery although it is most associated with cataract sugery (Irvine-Gass snydrome).

My surgeon was very familiar with my prior condition before the vitrectomy and made no indiction there was ever CME. At my 1-week follow up he noticed the pedaloid cysts had already occured.

Regardless, what would be a next step for me as the Kenalog appears to be having no real effect? (although it has only been 1 week)

Thank you for all your time with me
-Jeff

BTW: I'm in Central, IL and am willing to go wherever I need to if you have any recommendations.

Permalink Reply by Randall Wong, M.D. on February 15, 2012 at 12:55pm

If it has only been a week, I'd give it several weeks to even a few months. Be patient.

Stay in touch.

r

Permalink Reply by pryde on February 15, 2012 at 2:10pm

Thank you Dr.

Just so we are clear, I got the Kenalog injection 1 week ago but was on acular and pred-forte drops for 6 weeks before.

Are you saying the Kenalog normally takes several weeks to months to have any effect?

-Jeff

BTW: I just want you to know how much it means to me and other members that you are on here answering questions. We wait weeks and months to see an eye doctor and get only couple minutes of time. You are a real God-send. Thank you.

Permalink Reply by Randall Wong, M.D. on February 15, 2012 at 2:34pm

Ok. Where did you get the Kenalog? Actually inside the eye, or, outside the eye but underneath the conjunctiva or tenon's?

Can you see a white patch of medicine in the mirror?

You are welcome. I have written many articles on my blog about retinal disease. Participating here gives me a good idea of where we, as docs, can improve our delivery of information.

Thanks. Off to celebrate a 16th birthday.

Randy

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