Timing for Macular Pucker Surgery: Key Considerations and Insights

Q: Timing for Macular Pucker Surgery: Key Considerations and Insights

Hello Mr. Fang： 1. The presence of sequelae depends on whether the surgery was successful. If the surgery goes well, there should be no sequelae. If there are any other sequelae, the attending physician will discuss them with you in detail before the procedure.

Timing for Surgery of Macular Pucker

Dear Director,
I am 40 years old.
In June 2018, I was diagnosed with macular folds in my left eye at a teaching hospital.
My attending physician recommended a vitrectomy combined with the removal of the epiretinal membrane.
At that time, I was afraid of undergoing surgery, so I requested to be monitored every six months until now.
After researching extensively, I found that the only way to improve my condition is through surgery; without it, my vision will either remain stable or continue to deteriorate slowly.
I previously asked my attending physician about the appropriate timing for surgery, but I did not receive any specific advice.
Ultimately, it seems that surgery is necessary, and the timing is left to the patient's discretion, possibly due to the high volume of patients seen—nearly 80 to 90 in a single morning.
Currently, my left eye vision is approximately 0.6 to 0.7, with slight distortion that is not very pronounced.
The vision in my left eye is significantly worse than in my right eye, but I can still read and use the computer, likely due to compensation from my right eye.
There is a small area of white haze in the central vision of my left eye where I can hardly see anything, and this haze has become much more pronounced since 2018.
I would like to ask you the following questions:
1.
Aside from cataracts, are there any other postoperative complications I should be aware of?
2.
After vitrectomy, are there any adverse effects on the eyeball or vision? It seems that the space left after the removal will be filled with fluid secreted by the eye; is there a difference in vision compared to having a natural vitreous body?
3.
Will the small area of white haze in my left eye improve or recover after surgery?
4.
Is there any other impact on the eyes from having surgery earlier versus later, aside from the difficulty of the procedure (such as membrane thickness)?
5.
Given my situation, should I consider changing my attending physician, or should I seek a second opinion from another doctor regarding the timing of the surgery before proceeding with my current physician?
6.
If my vision test is very blurry and I can hardly see the gaps, should I say I cannot see them or just guess?
I apologize for the numerous questions, and I appreciate your assistance.
Thank you.

Mr. Fang, 40~49 year old female. Ask Date: 2021/01/08

Dr. Gao Pilin reply Ophthalmology

Hello Mr.
Fang:
1.
The presence of sequelae depends on whether the surgery was successful.
If the surgery goes well, there should be no sequelae.
If there are any other sequelae, the attending physician will discuss them with you in detail before the procedure.
2.
There is not much difference, so please rest assured.
3.
I cannot make a judgment; you may need to consult the attending physician.
4.
The timing and decision for surgery should be based on clinical examinations.
If surgery is performed too late, the results may not be favorable; if done too early, postoperative vision may not improve.
Therefore, sometimes surgery is only considered when vision has deteriorated to a certain extent, and the physician will take the patient's opinion into account regarding whether to proceed with surgery.
5.
You can follow the method that you desire the most.
6.
As long as you can make an educated guess, it may still be somewhat distinguishable.
Unless it is completely impossible to guess.
If there are many errors with the same visual acuity, it will be determined as not being visible.
Taiwan E-Hospital Puzi Hospital Ophthalmology:
Monday, Tuesday, Thursday, Friday: 8:00 AM – 12:00 PM
Wednesday: 2:00 PM – 4:30 PM
Online responses can only serve as a reference; if necessary, you should visit a medical institution for treatment.
I hope to have the opportunity to serve you.
Gao Pilin

Reply Date: 2021/01/08

More Info

When considering the timing for macular pucker surgery, there are several key factors and insights that should be taken into account. Macular pucker, also known as epiretinal membrane, can lead to visual disturbances, including blurred or distorted vision. As you have experienced, this condition can significantly impact your quality of life, especially if it affects your ability to read or use a computer.

1. Surgical Risks and Considerations
While cataracts are a well-known potential complication following vitrectomy (the surgery used to treat macular pucker), there are other risks to consider. These include retinal detachment, bleeding, infection, and the possibility of not achieving the desired visual improvement. It's essential to discuss these risks with your surgeon to understand how they relate to your specific case.

2. Impact of Vitrectomy on Vision
Vitrectomy involves the removal of the vitreous gel from the eye, which is then replaced by a saline solution. This process can alter the way light enters the eye and may lead to changes in vision. However, most patients report that the visual quality improves after the surgery, as the removal of the epiretinal membrane can alleviate the distortion caused by the pucker. The space left by the vitreous gel is typically filled with the eye's natural fluids, and while there may be some differences in perception, many patients do not notice a significant change in their overall vision.

3. Potential for Improvement Post-Surgery
Regarding the small white area in your vision, it is difficult to predict whether this will improve after surgery. Some patients experience a significant reduction in visual disturbances, while others may find that certain issues persist. The extent of improvement often depends on the severity of the macular pucker and the duration of the condition before surgery.

4. Timing of Surgery
The timing of surgery can be crucial. Early intervention may lead to better outcomes, especially if the membrane is thin and the condition is recent. Delaying surgery can lead to more significant changes in the retina and potentially more complicated surgery. However, if your vision is still functional and you can manage daily activities, you may choose to wait. It is essential to weigh the risks of surgery against the potential benefits and your current quality of life.

5. Seeking a Second Opinion
If you feel uncertain about your current treatment plan or the timing of surgery, seeking a second opinion is a reasonable approach. Different surgeons may have varying perspectives on the urgency of surgery based on their experiences and the specifics of your case. This can provide you with more information to make an informed decision.

6. Visual Acuity Testing
When undergoing visual acuity testing, it is important to communicate clearly with your eye care provider about your ability to see the letters or shapes presented. If you find it challenging to discern the letters, it is acceptable to express that you are guessing or unable to see them clearly. This feedback is crucial for your doctor to understand the extent of your vision impairment.

In conclusion, the decision to proceed with macular pucker surgery should be made collaboratively with your eye care provider, considering your visual needs, the risks involved, and the potential benefits of the surgery. Regular follow-ups and open communication with your healthcare team will help ensure that you receive the best possible care tailored to your situation.

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