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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8520
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I have been diagnosed with a well-developed macular pucker

Customer Question

I have been diagnosed with a well-developed macular pucker in my left eye. (Six weeks ago I had no symptoms whatsoever - other than being farsighted.)
I was instructed to return for a check-up in six months - unless my vision became significantly more distorted.
Assuming I will receive remedial treatment, what would that treatment consist of these days?
I am a 60-year-old Caucasian male. Thank you for your time and expertise.
Steve S.
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

I am a retina surgeon and deal with this issue at least every week.

Dr. Rick :

Do you know what your vision is in your affected eye at the moment?

Customer:

20/60

Dr. Rick :

Also, did your ophthalmologist say that your decreased vision is completely due to your macular pucker or do you have other issues such as cataracts etc.

Customer:

Attributed to macular pucker . . .

Dr. Rick :

Were you evaluated by an ophthalmologist (eye MD) or an optometrist?

Dr. Rick :

Also, do you know what your vision is in that eye? (20/20, 20/40 etc...)

Customer:

Initial appointment with optometrist who referred me to ophthalmologist with a mis-diagnosis of CSRS (?)

Dr. Rick :

CSR.....

Dr. Rick :

Ok.

Dr. Rick :

Well, I do not recommend doing anything for an epiretinal membrane (also called macular pucker) until vision drops below 20/40 as before that point the risks of the surgery are more then the risks of just leaving things alone.

Dr. Rick :

Treatment involves doing surgery, under local anesthetic, called a vitrectomy and membrane peel. In experienced hands it is very successful but in almost everyone a cataract will form sometime later, usually in a year or two and will require a second surgery to fix.

Dr. Rick :

Here is a very good web page from a very reliable source that discusses this condition in detail:

Customer:

Ok - but please note my vision in the left eye was measured to be 20/60 by the specialist (and 20/40 in my unaffected right eye.)

Dr. Rick :

I did a surgery for this condition last week and the patient has already noticed a decrease in the distortion he was experiencing, although his vision is not back 100% yet

Dr. Rick :

Well, at 20/60, with no other condition such as cataract contributing to your decreased vision, you would -- if you wanted to have surgery -- be a candidate, all other things being equal.

Dr. Rick :

But there is no rush to have surgery nor is there really any big risks to waiting.

Dr. Rick :

I cannot see anything that you are typing. Our chat system may not be working well at the moment. I'll switch over to the Q&A system. This system works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)

Expert:  Dr. Rick replied 1 year ago.
We have been experiencing technical difficulties with the chat system. Please allow me to retype my chat here for your review:


Dr. Rick : Hi. I'm online and happy to answer your question today.
Dr. Rick : I am a retina surgeon and deal with this issue at least every week.
Dr. Rick : Do you know what your vision is in your affected eye at the moment? Customer: 20/60
Dr. Rick : Also, did your ophthalmologist say that your decreased vision is completely due to your macular pucker or do you have other issues such as cataracts etc. Customer: Attributed to macular pucker . . .
Dr. Rick : Were you evaluated by an ophthalmologist (eye MD) or an optometrist?
Dr. Rick : Also, do you know what your vision is in that eye? (20/20, 20/40 etc...) Customer: Initial appointment with optometrist who referred me to ophthalmologist with a mis-diagnosis of CSRS (?)
Dr. Rick : CSR.....
Dr. Rick : Ok.
Dr. Rick : Well, I do not recommend doing anything for an epiretinal membrane (also called macular pucker) until vision drops below 20/40 as before that point the risks of the surgery are more then the risks of just leaving things alone.
Dr. Rick : Treatment involves doing surgery, under local anesthetic, called a vitrectomy and membrane peel. In experienced hands it is very successful but in almost everyone a cataract will form sometime later, usually in a year or two and will require a second surgery to fix.
Dr. Rick : Here is a very good web page from a very reliable source that discusses this condition in detail:
Dr. Rick : http://my.clevelandclinic.org/disorders/macular_pucker/hic_macular_pucker.aspx Customer: Ok - but please note my vision in the left eye was measured to be 20/60 by the specialist (and 20/40 in my unaffected right eye.)
Dr. Rick : I did a surgery for this condition last week and the patient has already noticed a decrease in the distortion he was experiencing, although his vision is not back 100% yet
Dr. Rick : Well, at 20/60, with no other condition such as cataract contributing to your decreased vision, you would -- if you wanted to have surgery -- be a candidate, all other things being equal.
Dr. Rick : But there is no rush to have surgery nor is there really any big risks to waiting.

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS


Please accept my apologies for the technical problems we have experienced with the chat system today.


I wills stand by in case you would like to continue our discussion......
Customer: replied 1 year ago.

To conclude our chat then, am I to understand that remedial procedures are limited to that of a vitrectomy, e.g., there is no "laser-related" procedure?


Your reply will suffice to conclude our conversation. Thank you for your input as well as the link to the Cleveland Clinic.


 


Steve S.

Expert:  Dr. Rick replied 1 year ago.
Steve,

That is correct. Laser won't work on this issue.

In January 2013 a new drug, called Ocriplasmin, was approved by the FDA to dissolve vitreous strands in a particular eye condition called vitreomacular traction. Perhaps someday this drug could be used to treat epiretinal membranes (although the pathology is different, so probably not)..... Only time will tell.


I wish you the very best. It sounds like you are in good hands.

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.

Once again, sorry about the chat system locking up on us :(

Have a good day.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8520
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 1 year ago.
Well Dr. Rick - how fortuitous for me that I get one more [free] question to you concerning my eye. Thank you!

Since it's no mystery that my ailment is a macular pucker, based on my research - as well as a satisfactory conference with my eye doctor [a specialist], I'm a little disconcerted at the speed and degree of my left eye's vision impairment. I understood that the condition had pretty much "stabilized." Apparently not so. Also - concerning the remedial surgery, isn't it true that once vitreous fluid is "lost" from the eyeball, it can never be replaced naturally or otherwise. If true, a replacement "air bubble" to maintain the proper shape of the eyeball seems to me to be a little bit tenuous - let alone subject to variations in barometric pressure. Thanks for your time and consideration spent on these additional questions. SR Sears 05/18/2013
Expert:  Dr. Rick replied 1 year ago.
Steve,

It is very possible that your macular pucker could get rapidly worse. This occurs more often then people think....

You do not need the vitreous and, once it is removed with surgery, the gas bubble goes away in a few days to a few weeks (depending on what gas is used...) and your body replaces the vitreous with natural fluids that maintain your eyes shape etc, so barometric pressure changes do not play a role....

Does this make sense to you?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

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Dr. Rick
Dr. Rick
Ophthalmologist & Retina Specialist
5459 Satisfied Customers
Ophthalmology since 1994 with Retina sub-specialty interest