Macular Pucker vs Macular Hole

Anonymous said...

Four years ago I was diagnosed with a macular pucker..at that time i do no recall the Dr. recommending surgery. during the past month my sight deteriorated drascally. last week dr said i had a hole in my macular and surgery was necessary. he thought this was fairly new. would i have got this hole if i would have the pucker repaired.

December 31, 2009 7:16 PM

Dear Anonymous:

There are several factors surgeons use for determining the need for surgery; one of the most obvious to the patient is visual acuity loss. No surgeon is going to be anxious to surgically enter an eye that is still seeing well unless there is an obvious potential for vision loss. Some macular puckers can spontaneously resolve while others can progress to a macular hole, unfortunately it sounds like you have experienced the latter. The good news is a fresh hole has a higher chance of successful repair.

Toni Kelly

Kelly Comfort Solutions

Sharon Fowler Ellis said...
Hey, I just started a blog about my own experience (in layman's terms) with a macular hole. I'm on day 9 after surgery.http://sharelli.blogspot.com/
August 15, 2009 3:22 PM

Thanks Sharon! I know you will get some hits! I didn't see your name in The Kelly Comfort Solutions customer rental database, but it sounds like you found the equipment you got helpful. I am as glad you found it helpful as you are glad you don't need it any more!

Toni Kelly
Kelly Comfort Solutions

my little window to the world

I had my operation 4 days ago and have been advised to face down 50 min out of every hour...I'm 38 years old and must admit I would have gone out of my mind if it wasn't for my iPhone-been able to watch films use Internet and control my pc all from my little window to the world...mind you, it doesn't stop the agony of back and neck ache, only 10 days to go...lol peter

Peter:
Ain't technology grand? Did you look into anything to help you maintain your position? If not, you may want to check out www.kellycomfort.com and give me a call. Maybe I can help!

Toni Kelly
Kelly Comfort Solutions

What vision can I expect after surgery?

I'm schedule to have surgery 8/10 and have gotten the support system to make the 1 week initial recovery time go by much easier. What should I expect after the surgery is over? I presently have a slight central vision blind spot and remaining vision is very blurry. Anonymous

Dear Anonymous:
Visual outcome after macular hole repair is difficult to predict. Generally your surgeon would not offer the surgery if he/she did not think there could be visual improvemnet. Macular hole repair will only affect the central vision; if your peripheral vision is blurry due to another disease process it is unlikely to get better. For those that get the "pinched together in the middle" effect on the Amsler Grid, it is hoped the distortion will be significantly decreased. Those with a full thickness hole causing a central scotoma or blind spot can hope for central vision to return, ideally to a well functioning level. So many factors determine what any individual outcome will be - your surgeon should be able to provide you with his best estimate.

And don't forget, your vision will be WORSE immediately after the surgery due to the bubble. You will start to note improvement aas the bubble reabsorbs.

Toni Kelly
Kelly Comfort Solutions

Macular Hole after previous surgery

Hi I will be having this procedure done on September 2. As you can imagine, I am very nervous as I have had problems with my eys for many years. I am 57 and after I gave birth to my daughter in 1983 I was diagnosed with a detached retina in my right eye. A scleral buckling and sponge procedure was done at that time. In 1996 I developed cateracts in both eyes and had lens implants. Now I have a MH in my right eye. I can see ok at a distance, etc. but cannot read well unless I close that eye. I am so nervous about my eyesight. If the procedure does not take, will I lose what eyesight I have now in my right eye and will this procedure, in fact, make it worse? Thank you for any input.
Anonymous

Dear Anonymous:

The surgery to repair your macular hole will be a little different from the procedure you had done years ago for the detached retina. Of the two surgeries, and of the two problems for that matter, the macular hole and its repair is the preferable. It is still a delicate surgery but success rate is very high. The fact that you have had previous retinal surgery makes you different from the majority of MH repairs and your retina surgeon would be the best source of information about what your particular prognosis is. Unless you have the unfortunate luck to get an infection in the eye it is very unlikely that your vision would get any worse even if the surgery does not repair the hole. Good luck and let me know how it goes!

Toni Kelly
Kelly Comfort Solutions
Vitrectomy Support Equipment Rentals

Anonymous said...
I had surgery for a macular pucker and surgeon fixed a small macular hole 11 days ago. The bubble is a small semi circle now and I can see over it. I have small black dots floating around, still have noticable double vision and wavy horizonal lines. Is this to be expected?

June 8, 2009 9:28 AM

Dear Anonymous:

It is difficult to determine what your final vision will be like until the bubble is gone. While everyones experience is a little different, almost everyone notices being able to see "over the bubble" and many see the dots you mention. The bubble itself is distorting and cause your other complaints but be sure to mention all of this to your surgeon when you see him/her!

Toni

Is their anything that truly is the VERY BEST for comfort?

Hello, my surgery will be March 12Th for MH. I am thankful to know the surgery will prevent further sight distortion in my eye but am VERY CONCERNED about positioning recovery. I Have RA/ LUPUS/ Sjgorens Syndrome so I have 24/7 pain in normal life....Is their anything that truly is the VERY BEST for comfort while face down recovery?
God Bless Each Who Are Having This Problem, I am so very tankful these past few years they have found a successful surgery and treatment plan for us with MH problems.
Thank you,
Evelyn

Evelyn:
THE BAD NEWS: there is nothing that is going to make vitrectomy recovery easy.
THE GOOD NEWS: there are things that can help.

Most companies offer very similar items; they are all designed to allow your neck, back and shoulder muscles to get some releif from the torture of maintaining the proper positioning. Everybody is different and only you know what you need to get yourself through. Some people do it with no equipment at all! For a look at some of the items available for relief take a look at the vitrectomy positioning devices on my website: www.KellyComfort.com Good Luck!
Toni Kelly

Anonymous said...
i had an eye surgery with the gaseous bubble and was told by my doctor to remain face-down for 7 days. then i'll return to another appointment, when i assume he'll check that the hole is healed and, if so, i assume i can raise my head.

is it at this point that the bubble starts dissipating?

also, i've noticed that on the occasions when i do raise my head - for eye drops, for example - that i feel dizzy and light-headed. has anyone else experienced this? when did it start going away?

also, i've noticed a lot of very lengthy recovery times, which i assume are affected by diabetes or other, additional medical issues. has anyone recovered in 7 days and what was the recovery experience after that? i'm trying to figure out (a little ahead of time) whether i should plan to go back to work or not - and whether i should park my car for a month.

i would really appreciate anyone's experience. thanks

February 9, 2009 10:12 PM

Dear Anonymous:

The gas bubble initially grows over the first few days then gradually dissipates. Depending upon the type of gas used, the bubble will disappear in approximately 2-6 weeks. When to raise your head is variable among surgeons and your particular case, just as you inferred. Your ability to drive once you are released to raise your head will largely be your call. The resisdual bubble may interfere with your depth perception so you will need to be careful. The lightheaded feeling you have experienced when raising your head is not uncommon, especially if you have done a very good job of keeping your face down.

Toni

Long Standing Macular Hole

Anonymous said...
is it possible to repair a long-standing full-thickness macular hole? my daughter injured her eye at age 2 (she's 26 now). there was a macular pucker to begin; the opthamologist had her see a retinal specialist at age 3; she was uncooperative and specialist didn't get a good look. then by age 6 the opthamologist suggested she see the retinal specialist again, who then confirmed she had a full-thickness retinal hole. I've always hoped that the technology would improve to the point that repair would be possible.

February 9, 2009 11:41 PM

Dear Anonymous:
I believe it would be highly unlikely to achieve much improvement in vision after such a great length of time. Generally surgeons want to repair a macular hole within 6 months, a year at most. There may be a surgeon out there who would perform the surgery but unfortunately the prognosis is not good. Toni

Anonymous said...
My husband cancelled his surgery yesterday. He thinks he has had a MH for over 4 years. He only just realized he had distorted vision when after many pairs of glasses didn't help. He actually had to tell the eye Dr that the print in emails where distorted over and over again, and that is when the Dr looked even deeper into his eye and suspected MH. He was then referred to a specialist. We went for another opinion and the same bad news was given so he chose to have surgery. The night before surgery he realized that after 4 years the hole or should I say his distorted vision hasn't gotten worse, so why should he risk having surgery that may or may not work, or could even make it worse, and that it will eventually lead to cataract surgery and lens replacement with in a year or two. He also feels that it may be getting better after using steroid drops for only 30 days. (Recommended by Dr before electing to get surgery) Do you think that after this many years his hole will not enlarge and that another round of steroid drops will help, or even stop the hole from enlarging? I've read all the good and bad responses in many blogs and quite frankly it seems sometimes it may be better to just wait it out. He see's quite well out of that eye now, only a little distortion. Can't he just be monitored monthly to see if the hole is enlarging? He is really struggling with this. We shipped your equipement back today, which seemed to be the answer if he had gone through with the surgery. Do you have any cases where the hole edges healed and the patient is doing fine and maintaining the same vision for many years? Thank you in advance for your responce.

November 25, 2008 1:38 PM

Recommended surgeons for macular hole repair

Anonymous said...
Hello,
I am in Italy and need an advice. If you had your child with a macular hole due to a thrauma, and have to go to the best specialists in US to have him operated, where would you bring him?

Thank you so much, it's crucial for us to know the right places-names.

November 16, 2008 10:43 AM



Whew-I am truly flattered, yet humbled, by your question.

I am very proud that you believe coming to the United States of America for medical treatment is the right first step. I believe it too. However, I am afraid it would be inappropriate for me give a particular name or practice; I am personally not qualified to make a determination of any particular surgeons abilities. I can recommend choosing a Board Certified Retinal Surgeon; all have ideally reached a minimal level of competance in order to attain their title.

I have personally seen the expertise and outcomes of several retinal surgeons, but only in the Pittsburgh, PA area. Of the surgeons I have had the experience of working with, I can say with sincerity I would trust a couple of them with my own child. There are several surgeons and practices in other regions that have achieved world wide reputations for their research and prominent journal contributions but the truth of the matter is what you want and need is experience and ability in the operating room.

And now I am going to stick my neck out, just a little. I advise that you be sure the surgeon you choose to treat your child is the same surgeon who actually performs the surgery, this is particularly important if you are being seen in a teaching hospital facility.

Good luck to you and your child.
Toni

Good informative website...

This Retina-Vitreous Center in NJ does a great job of explaining macular and retinal diseases. If you are interested in macular degeneration treatment trials be sure to look at their Retina scope newsletter from January 2008. Cut and paste the following link:
http://www.retinavitreouscenter.com/patient_education_macular.html#macular_hole

American Society of Retina Specialists Convention

I am excited to be attending the American Society of Retinal Specialists convention next week. Five years out of the clinical setting makes it essential I attend conventions to try and freshen up on the new and exciting progress in the retinal world. It doesn't hurt that the convention is being held on the island of Maui! This is my first tip back to Hawaii since holding my very first position in an ophthalmology practice. I was an ophthalmic assistant at the Hawaiian Eye Center under the direction of John M. Corboy, MD. He was a pioneer in cataract surgery and used the phacoemusification technique and refractive nuances to achieve an extraordinary percentage of naked visions under 20/40. And that was in 1989! Not to mention he was quite the business man. He encouraged me to get certified as an assistant, I was a youngster of 23 at the time. Later I certified as a technician and learned the skill of fluorescein angiography.

As I mentioned after a convention in New Orleans earlier in the year, there doesn't seem to be a great amount of change happening in the surgery for macular holes, but whatever is happening I aim to keep up with. A recent customer was involved in a study in California using some new techniques I hope to learn more about.

One of the few surgeons most adamant about the lack of a need to position face down after macular hole surgery will be there, Paul Tornambe, MD. When I met Dr. Tornambe at the ASRS convention in New York in 2003 he told me I would probably be in business for about five more years before face down positioning would be obsolete. Certainly the standard two weeks of positioning has fallen to more like 7- 10 days, but by far, most retinal surgeons continue to require patient compliance with the face down recovery process. Some retinal surgeons, even while requiring their patients to position, feel the positioning equipment my business revolves around is unnecessary or too costly. It is true some patients get through the recovery successfully without assistance, but no one is going to say it is easy. I cannot please everyone every time, but I continue to stay in business because many people are served well by Kelly Comfort and by me.

Undoubtedly, I will have much to learn next week about the progress being made in the treatment of macular degeneration. Really exciting things are happening there. When I left clinical work in 2003 I was actively involved with the latest treatment for exudative macular degeration at the time, Photodynamic Therapy or PDT. The practice I worked for in Pittsburgh, PA was involved in the clinical trials before it became FDA approved. It was an exciting time, but wow, the stuff they are doing now...I'll be taking lots of notes.

I look forward to sharing whatever I learn with you!

Reader Questions and Suggestions

Hi Kelly;
I have been referred to a vitreoretinal surgeon for a macular hole in
my left eye. However, I have this strong feeling that I have it in my
right eye as well. (I was diagnosed with macular puckers in both eyes
earlier this year). The vision problems in each eye are different --
left eye is blurry central vision spot; right eye is difficulty
focusing and what appears to be a "central floater".

I see a surgeon next Friday, but am curious. When both eyes are
involved, is surgery generally performed on both eyes at the same time,
or are they typically done at different times? Just curious. This
waiting to see the surgeon next week is difficult.

Linda


Hi Linda:

Vitrectomy surgery is done one eye at a time. The risk of post
operative infection is very, very small but if infection occurs it can
be devastating. It would be difficult to contain an infection to one
eye therefore, the benefits of doing a bilateral surgery, if there are
any, are far and away outweighed by the risks.

Linda, this is a very good question and one in which others may be
interested. May I post your question on my blog:
vitrectomy.blogspot.com ?

Toni Kelly

Exhaustion during vitrectomy recovery

Wondering if you have heard of any symptoms such as tiredness or foggy head during the bubble dissipatingstage. 10 days ago, I felt great and on the mend. Then, as the bubble started to divide, I noticed feeling exhausted. I feel like I'm not myself 5 weeks after surgery!The surgeon changed from my steroid drops to non-steroidal anti-inflammatory two days ago. I noticed aslight improvement but still exhausted.Ever heard of these symptoms in the late stages of bubble dissipation?

Dear Anonymous:
A feeling of nausea or seasickness from the movement of the bubble as it becomes visible is not an uncommon complaint. It sways in the eye with movement and gives the effect of looking out at an ocean from a boat. The complaint of exhaustion I am not familiar with however. You have done the right thing by mentioning it to your surgeon and I would advise you to continue keeping him or her informed. I would like to hear from anybody else who has experienced these symptoms of exhaustion or foggy head.

What if I don't get my macular hole repaired?

HI,I AM LITA. LAST JUNE MY EYE DOC. SAYS I HAVE MACULAR HOLE. i WAS READY TO HAVE IT DONE BUT BY THE TIME I LEARNED ABOUT THE RECOVERY PROCESS I CANCELED IT. i HAVE IT ON THE RIGHT EYE. THINKING ABOUT IT IS UNBEARABLE I DO NOT HAVE THE ENERGY TO HAVE MY FACE DOWN FOR AT LEAST 2 WEEKS OR SO. IF I DON'T DO IT WILL IT GET WORSE OVER TIME? what IS THE BEST THING TO DO. Any IDEA HOW MUCH IT COSTS TO HAVE IT DONE?

Dear Lita:

The recovery does sound worse than the surgery doesn't it? That's because it is! However, it is not unachievable and people do it everyday. Your fear is not unreasonable, but you need to understand that the hole will probably not get better on its own. There are cases of holes spontaneously closing, but they are unusual. I cannot give a definite answer to your question about whether your hole will get worse or not. It may get bigger, depending on its size now. Rarely, retinal detachments occur, a MUCH bigger problem that can affect your entire field of vision. Mostly, macular holes left untreated leave you with a dark spot right in the center of your vision which makes it very difficult, maybe even impossible, to read with the affected eye. Probably the best argument for proceeding with the surgery is that one day something could happen to your other eye that would leave your right eye your "better" eye. Would you be able to drive or read if you lost your left eye? Something to think about. The likelihood of surgical success is better with a fresher hole. Conventional wisdom says it is better to operate on a macular hole that is less than a year old.

As for the cost of the surgery, your surgeon's billing person should be able to provide you with the cash cost but most insurance companies will cover this type of surgery (though they may not cover the cost of the rental equipment).

Toni Kelly

Vitrectomy while pregnant.

Hi, I came across your blog and website while looking into vitrectomy recovery options. I am likely to have my second surgery this coming friday. I had a scleral placed a week ago that unfortunately did not completely fix my retinal detachment. My doctor said the vitrectomy with the gas bubble is the next option, one were we hoping to avoid. I am currently 21 weeks pregnant, and so of course the face down recovery is presenting some interesting issues since obviously my stomach is going to be in the way. I was wondering if anything that your company has may be useful for the recovery, maybe even cushions geared towards the obese that may be able to support and pad the stomach area in my situation. Thanks for any advice you can offer. ~Beth

Beth:

There is a product used for massages on pregnant women called the Prego Pillow. www.pregopillow.com The spa I went to used one when I was pregnant and it was pretty good. I have considered adding one to my product line several times. Good luck!
Toni Kelly

A Testimony

Anonymous said...
i have had surgery two weeks ago and if wasn't for the massage table and the massage chair i would have not made it! i put a 19" tv under the chair and watched tv for hrs. the cahir is the life saver. bless you all, if i did it anyone can. good luck to everyone :)

How long are you restricted?

Lynne said...
hi thereMy Mom who is almost 72 will be having the operation (gas) for a macular hole in early June. She is, understandably, very nervous. She is also the primary caregiver for my Dad.She is wondering how long after the operation until you can exercise again - she takes private fitness training and has to come to an arrangement with the trainer for her time off. I know it will vary by person, but are we looking at months or weeks?Also, does anyone know where we can rent these great equipment options in Canada? We think we have found a place where she can get a massage table, but I would love for to have some of the stuff I have seen in Britain and the U.S. where she could sit at a table. She has arthritis and is very worried about having to lie down for so long.thanks in advanceLynneottawa_lynne@yahoo.ca

Toni Kelly said...
Lynne:How long it will take to return to normal activities is variable. The bubble itself will last for at least a few weeks or longer, limiting things such as flying or traveling to higher elevations (the gas inside the eye can expand at high altitudes). Your mother's surgeon will be able to give you the best answer to her particular activities.There is a company in Ontario called Labtician Ophthalmics that carries Vitrectomy Support equipment. 1-800-265-8391

Suggestions for the obese

Anonymous said...
I will be having surgery very soon. Have lots of entire cervical pain due to injuries-healed compressed vertebrae fractures--still hurt, knee pain, surgery and need more on other knee. Shoulder andarm pains, tingling in arms hands fingers, when in bed especially -old injuries and substandard medical care for most--MY question: I am obese-cannot dance or exercise anymore-and breasts bunch up and hurt if I am at foot of bed and of course back strain etc. How can i sleep with head rest at end of bed-or on bed-and prevent Pain from breasts? I am practicing and realize it will be painful unless some supoort around breasts. What do you recommend?

Toni Kelly said...
Dear Anonymous:Wow, as if it wasn't difficult enough to do this positioning thing! There is a sternum pad that can be used with the seated support chair that fits between the breasts, and many doctors will allow you to sleep on your side(they will tell you which side depending on which eye you are having worked on) as long as you turn your head way to the side. It isn't ideal but some people just cannot, for a variety of reasons, sleep on their stomach . Does anyone out there have any ideas?