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Chronological events recently - Mid September 2018, sudden appearance of

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Posted on Fri, 15 Mar 2019
Question: Chronological events recently
-     Mid September 2018, sudden appearance of a large floater in RIGHT eye. Eye for examination, no retinal tear or detachment. Doctor said no problem, diagnosis is PVD.
-     1 Dec, I saw sudden increase in floaters in LEFT eye. Went to doctor for urgent examination, and found vitreous hemorrhage. Dr said no treatment required, the blood will be gradually absorbed on its own. (I guessed it may be due to a massage done the day prior when area around eye bone below eyebrow and near the nose was pressed hard during massage. But doctor said unlikely ).
-     Follow up consultation on 8 XXXXXXX 2019. Dr examined both eyes, and found OK. No more blood seen on left eye. Right eye is also fine.
-     But on 27 XXXXXXX 2019, I suddenly found my vision of RIGHT eye a bit strange, with a wavy dot in central vision. Consulted doctor and found with epirectinal membrane for right eye. Then did OCT on 1 Feb, confirming RIGHT eye ERM.
-     Seek second opinion on 11 Feb, Dr also advised surgery for RIGHT eye ERM.. Also found a small tear on LEFT eye (ie. the other eye without ERM) and done laser on the same day.

Current vision / feeling –
-     In doing eye examination when seeking second opinion early this week, corrected visual acuity is 20/25.
-     If I cover up my left eye, I have burred vision and feel like there is a thin layer in front, also stragiht line looks wavy. Sometimes with a light yellowish spot in central vision if background is bright or light colour. If use both my eyes to see, basically OK, but a bit hard when look at computer monitor while reading paper is OK. But sometimes feel the vision of both eyes not very balanced, feel vision a bit unnatural.
-     First Dr’s medical notes marked down Grade one ERM, striae . Both doctors advised surgery. My OCT report is uploaded
-     Both doctors said my lens of both eyes are clear, no sign of cataract.
-     For RIGHT eye, I often see some “branches” images (look very like eye blood vessels images I see when ophthalmologist examines my retina in Indirect ophthalmoscopy) when blinking my eyes, especially when I move from a darker to brighter environment e.g when switch on the light after waking up)


My questions
1.     I have several eye examinations since Sep 2018 but doctor has not mentioned ERM at all. Everything is fine in 8 XXXXXXX eye examination, but suddenly three weeks later, ERM is found in late XXXXXXX Can ERM be formed so acutely? What is the likely cause in my case?
2.     Is at advisable to go for surgery at this stage? Or could I wait and observe for period of time? Will ERM cause macular hole or retinal detachment?
3.     I am scared by the risk of surgery. Worried that the process of peeling off the membrane may hurt the retina and cause other complications leading to damage to vision. Can the OCT give any hint on the complexity/risk of the surgery in my case (e.g. size and thickness of the membrane, whether the membrane is very close/connected with the retina making it more difficult for peeling, etc)?
4.     The irst doctor said no need to inject gas to eyeball after surgery (thus no need for posture control). But second doctor said yes (need posture control for two days) as this could improve macular edema better and faster. I am confused. Is gas injection necessary? Any possible side effects for gas injection? Could it provide added benefits in my case, while weighing against its potential side effects/risks?
5.     First doctor said that cataract will be developed (within about 1st year of surgery) for 70% of patients undergoing such surgery. Why this could lead to cataract? Can anything be done to prevent or delay its occurrence?
6.     The first doctor said I can choose complete or partial vitrectomy. Complete vitrectomy lead to cataract faster, partial vitrectomy can delay cataract but I will have some floaters left. But 2nd doctor advised complete vitrectomy. Which option is more advisable? How to choose? What factors to consider?
[I am concerned about cataract. If I need to do cataract surgery soon for RIGHT eye after ERM surgery, I will also need to replace my lens of left eye? (because of the great difference between my left eye (with – 850 degree myopia) and my right eye by that time will be myopia corrected after cataract surgery)? I am concerned to have the lens of left eye replaced when it is still clear and function well)
7.     Why I see the “branches” images for the right eye when blinking eyes ? Can it be due to the epiretinal memberance? One doctor said it is floaters, and one doctor said it may be the afterimages of eye blodd vessels. I am confused.
8.     Any long term complications/risks of other eye diseases (e.g. glaucoma, retinal detachment, macular hole, macular degeneration,etc) after doing the ERM surgery?
9.     Is ERM an indicator that I will have higher chance of getting macular diseases like macular hole, age related macular degeneration ?
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Follow up: Dr. N. K. Misra (0 minute later)
Chronological events recently
-     Mid September 2018, sudden appearance of a large floater in RIGHT eye. Eye for examination, no retinal tear or detachment. Doctor said no problem, diagnosis is PVD.
-     1 Dec, I saw sudden increase in floaters in LEFT eye. Went to doctor for urgent examination, and found vitreous hemorrhage. Dr said no treatment required, the blood will be gradually absorbed on its own. (I guessed it may be due to a massage done the day prior when area around eye bone below eyebrow and near the nose was pressed hard during massage. But doctor said unlikely ).
-     Follow up consultation on 8 XXXXXXX 2019. Dr examined both eyes, and found OK. No more blood seen on left eye. Right eye is also fine.
-     But on 27 XXXXXXX 2019, I suddenly found my vision of RIGHT eye a bit strange, with a wavy dot in central vision. Consulted doctor and found with epirectinal membrane for right eye. Then did OCT on 1 Feb, confirming RIGHT eye ERM.
-     Seek second opinion on 11 Feb, Dr also advised surgery for RIGHT eye ERM.. Also found a small tear on LEFT eye (ie. the other eye without ERM) and done laser on the same day.

Current vision / feeling –
-     In doing eye examination when seeking second opinion early this week, corrected visual acuity is 20/25.
-     If I cover up my left eye, I have burred vision and feel like there is a thin layer in front, also stragiht line looks wavy. Sometimes with a light yellowish spot in central vision if background is bright or light colour. If use both my eyes to see, basically OK, but a bit hard when look at computer monitor while reading paper is OK. But sometimes feel the vision of both eyes not very balanced, feel vision a bit unnatural.
-     First Dr’s medical notes marked down Grade one ERM, striae . Both doctors advised surgery. My OCT report is uploaded
-     Both doctors said my lens of both eyes are clear, no sign of cataract.
-     For RIGHT eye, I often see some “branches” images (look very like eye blood vessels images I see when ophthalmologist examines my retina in Indirect ophthalmoscopy) when blinking my eyes, especially when I move from a darker to brighter environment e.g when switch on the light after waking up)


My questions
1.     I have several eye examinations since Sep 2018 but doctor has not mentioned ERM at all. Everything is fine in 8 XXXXXXX eye examination, but suddenly three weeks later, ERM is found in late XXXXXXX Can ERM be formed so acutely? What is the likely cause in my case?
2.     Is at advisable to go for surgery at this stage? Or could I wait and observe for period of time? Will ERM cause macular hole or retinal detachment?
3.     I am scared by the risk of surgery. Worried that the process of peeling off the membrane may hurt the retina and cause other complications leading to damage to vision. Can the OCT give any hint on the complexity/risk of the surgery in my case (e.g. size and thickness of the membrane, whether the membrane is very close/connected with the retina making it more difficult for peeling, etc)?
4.     The irst doctor said no need to inject gas to eyeball after surgery (thus no need for posture control). But second doctor said yes (need posture control for two days) as this could improve macular edema better and faster. I am confused. Is gas injection necessary? Any possible side effects for gas injection? Could it provide added benefits in my case, while weighing against its potential side effects/risks?
5.     First doctor said that cataract will be developed (within about 1st year of surgery) for 70% of patients undergoing such surgery. Why this could lead to cataract? Can anything be done to prevent or delay its occurrence?
6.     The first doctor said I can choose complete or partial vitrectomy. Complete vitrectomy lead to cataract faster, partial vitrectomy can delay cataract but I will have some floaters left. But 2nd doctor advised complete vitrectomy. Which option is more advisable? How to choose? What factors to consider?
[I am concerned about cataract. If I need to do cataract surgery soon for RIGHT eye after ERM surgery, I will also need to replace my lens of left eye? (because of the great difference between my left eye (with – 850 degree myopia) and my right eye by that time will be myopia corrected after cataract surgery)? I am concerned to have the lens of left eye replaced when it is still clear and function well)
7.     Why I see the “branches” images for the right eye when blinking eyes ? Can it be due to the epiretinal memberance? One doctor said it is floaters, and one doctor said it may be the afterimages of eye blodd vessels. I am confused.
8.     Any long term complications/risks of other eye diseases (e.g. glaucoma, retinal detachment, macular hole, macular degeneration,etc) after doing the ERM surgery?
9.     Is ERM an indicator that I will have higher chance of getting macular diseases like macular hole, age related macular degeneration ?
doctor
Answered by Dr. N. K. Misra (2 days later)
Brief Answer:
ERM Surgery

Detailed Answer:
Hello and welcome to Ask A Doctor service.

I have reviewed your query and here is my advice.

1. I have several eye examinations since Sep 2018 but doctor has not mentioned ERM at all. Everything is fine in 8 XXXXXXX eye examination, but suddenly three weeks later, ERM is found in late XXXXXXX Can ERM be formed so acutely? What is the likely cause in my case?

Such acute formation of ERM is extremely rare. But since you had visual problems only recently, I assume the ERM is of recent origin. Early ERMs may be missed easily if careful examination is not done or an OCT has not been performed. As you have mentioned there was a PVD in your right eye, that might have obscured the view some how leading to missing the ERM. It tough to predict the cause in your case as of now.

2. Is at advisable to go for surgery at this stage? Or could I wait and observe for period of time? Will ERM cause macular hole or retinal detachment?

In my opinion you can wait for a while, observe the ERM and its progression. We usually operate on ERMs when the visual acuity is 20/100 or less or there is significant distortions. Having said that, there are different institutional protocols and I would leave the decision for surgery on the attending physician and the patient.

ERMs are known to cause a type of macular holes called as lamellar holes, which usually resolve after the ERM is removed.

ERMs will not lead to a Retinal Detachments.

3. I am scared by the risk of surgery. Worried that the process of peeling off the membrane may hurt the retina and cause other complications leading to damage to vision. Can the OCT give any hint on the complexity/risk of the surgery in my case (e.g. size and thickness of the membrane, whether the membrane is very close/connected with the retina making it more difficult for peeling, etc)?

All surgical procedures come with a list of possible complications. But, if done in the right hands, chances of theses complications a re negligible. OCT will definitely help in guiding the surgeon in formulating the perfect surgical plan. If the choice of surgeon is good, chances of any complications are very less.

4. The irst doctor said no need to inject gas to eyeball after surgery (thus no need for posture control). But second doctor said yes (need posture control for two days) as this could improve macular edema better and faster. I am confused. Is gas injection necessary? Any possible side effects for gas injection? Could it provide added benefits in my case, while weighing against its potential side effects/risks?

The use of Gas tamponade is again at surgeons discretion, I don’t prefer to give gas but others do. There is a claim that gas tamponade will help in faster recovery. Its not necessary to put gas. If you don’t live at a high altitude there are no serious side effects.

5. First doctor said that cataract will be developed (within about 1st year of surgery) for 70% of patients undergoing such surgery. Why this could lead to cataract? Can anything be done to prevent or delay its occurrence?

There are high chances of cataract development after any retinal surgery. Removal of vitreous during surgery leads to increased oxygen tension in the eye which causes lens fibre oxy\idation and hence the cataract. Sadly, nothing much can be done about it. But, cataract surgery is a relatively simple procedure with least complications.

6. The first doctor said I can choose complete or partial vitrectomy. Complete vitrectomy lead to cataract faster, partial vitrectomy can delay cataract but I will have some floaters left. But 2nd doctor advised complete vitrectomy. Which option is more advisable? How to choose? What factors to consider?

Bette to go for complete vitrectomy, being a myopic it will prevent other complications in the future as well.

[I am concerned about cataract. If I need to do cataract surgery soon for RIGHT eye after ERM surgery, I will also need to replace my lens of left eye? (because of the great difference between my left eye (with – 850 degree myopia) and my right eye by that time will be myopia corrected after cataract surgery)? I am concerned to have the lens of left eye replaced when it is still clear and function well)

Cataract surgery wont be needed immediately after ERM surgery. It will grow slowly, if at all it develops.

7. Why I see the “branches” images for the right eye when blinking eyes ? Can it be due to the epiretinal memberance? One doctor said it is floaters, and one doctor said it may be the afterimages of eye blodd vessels. I am confused.

This is known as the entoptic phenomenon and is a normal things. Please don't worry about it.

8. Any long term complications/risks of other eye diseases (e.g. glaucoma, retinal detachment, macular hole, macular degeneration,etc) after doing the ERM surgery?

Apart from development of cataract, an uneventful ERM survey will lead to np other eye disease.


9. Is ERM an indicator that I will have higher chance of getting macular diseases like macular hole, age related macular degeneration ?

No, apart from possibility of a macular holes it will lead to no other macular disease.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. N. K. Misra (0 minute later)
Brief Answer:
ERM Surgery

Detailed Answer:
Hello and welcome to Ask A Doctor service.

I have reviewed your query and here is my advice.

1. I have several eye examinations since Sep 2018 but doctor has not mentioned ERM at all. Everything is fine in 8 XXXXXXX eye examination, but suddenly three weeks later, ERM is found in late XXXXXXX Can ERM be formed so acutely? What is the likely cause in my case?

Such acute formation of ERM is extremely rare. But since you had visual problems only recently, I assume the ERM is of recent origin. Early ERMs may be missed easily if careful examination is not done or an OCT has not been performed. As you have mentioned there was a PVD in your right eye, that might have obscured the view some how leading to missing the ERM. It tough to predict the cause in your case as of now.

2. Is at advisable to go for surgery at this stage? Or could I wait and observe for period of time? Will ERM cause macular hole or retinal detachment?

In my opinion you can wait for a while, observe the ERM and its progression. We usually operate on ERMs when the visual acuity is 20/100 or less or there is significant distortions. Having said that, there are different institutional protocols and I would leave the decision for surgery on the attending physician and the patient.

ERMs are known to cause a type of macular holes called as lamellar holes, which usually resolve after the ERM is removed.

ERMs will not lead to a Retinal Detachments.

3. I am scared by the risk of surgery. Worried that the process of peeling off the membrane may hurt the retina and cause other complications leading to damage to vision. Can the OCT give any hint on the complexity/risk of the surgery in my case (e.g. size and thickness of the membrane, whether the membrane is very close/connected with the retina making it more difficult for peeling, etc)?

All surgical procedures come with a list of possible complications. But, if done in the right hands, chances of theses complications a re negligible. OCT will definitely help in guiding the surgeon in formulating the perfect surgical plan. If the choice of surgeon is good, chances of any complications are very less.

4. The irst doctor said no need to inject gas to eyeball after surgery (thus no need for posture control). But second doctor said yes (need posture control for two days) as this could improve macular edema better and faster. I am confused. Is gas injection necessary? Any possible side effects for gas injection? Could it provide added benefits in my case, while weighing against its potential side effects/risks?

The use of Gas tamponade is again at surgeons discretion, I don’t prefer to give gas but others do. There is a claim that gas tamponade will help in faster recovery. Its not necessary to put gas. If you don’t live at a high altitude there are no serious side effects.

5. First doctor said that cataract will be developed (within about 1st year of surgery) for 70% of patients undergoing such surgery. Why this could lead to cataract? Can anything be done to prevent or delay its occurrence?

There are high chances of cataract development after any retinal surgery. Removal of vitreous during surgery leads to increased oxygen tension in the eye which causes lens fibre oxy\idation and hence the cataract. Sadly, nothing much can be done about it. But, cataract surgery is a relatively simple procedure with least complications.

6. The first doctor said I can choose complete or partial vitrectomy. Complete vitrectomy lead to cataract faster, partial vitrectomy can delay cataract but I will have some floaters left. But 2nd doctor advised complete vitrectomy. Which option is more advisable? How to choose? What factors to consider?

Bette to go for complete vitrectomy, being a myopic it will prevent other complications in the future as well.

[I am concerned about cataract. If I need to do cataract surgery soon for RIGHT eye after ERM surgery, I will also need to replace my lens of left eye? (because of the great difference between my left eye (with – 850 degree myopia) and my right eye by that time will be myopia corrected after cataract surgery)? I am concerned to have the lens of left eye replaced when it is still clear and function well)

Cataract surgery wont be needed immediately after ERM surgery. It will grow slowly, if at all it develops.

7. Why I see the “branches” images for the right eye when blinking eyes ? Can it be due to the epiretinal memberance? One doctor said it is floaters, and one doctor said it may be the afterimages of eye blodd vessels. I am confused.

This is known as the entoptic phenomenon and is a normal things. Please don't worry about it.

8. Any long term complications/risks of other eye diseases (e.g. glaucoma, retinal detachment, macular hole, macular degeneration,etc) after doing the ERM surgery?

Apart from development of cataract, an uneventful ERM survey will lead to np other eye disease.


9. Is ERM an indicator that I will have higher chance of getting macular diseases like macular hole, age related macular degeneration ?

No, apart from possibility of a macular holes it will lead to no other macular disease.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
default
Follow up: Dr. N. K. Misra (3 days later)
Dear Dr Misra,

Thanks much for your reply. Very useful. I have some follow-up questions –
1.     My RE vision is now around 20/30, but I have image distortion if LE is covered up. When using both eyes, I feel unbalanced vision and a bit uneasy. Compared to day 1 when ERM was found (4 weeks ago), I noticed my image distortion has worsened, plus my ERM formed so acutely, does it imply that it will progress quickly?

2.     If I do not do surgery now, will it cause macular hole over time? You mentioned lamellar holes, will it progress to macular hole over time? how long should wait and observe and what examination should I do during the waiting period? Eye examination by doctor or another OCT?

3.     Is the difference between gas injection and no gas injection only on the time taken for recovery, i.e. if I do not inject gas tamponade, my vision will eventually recover and improve to the same extent under the scenario of gas injection but only takes a longer time?

4.     Any cons for gas injection? I heard that gas injection may further accelerate cataract (in addition to the acceleration due to oxidization after vitrectomy)

5.     What is the chance of developing cataract after vitrectomy? I heard that it is up to 60-70 % within the first year of vitrectomy.

6.     For entoptic phenomenon you mentioned, I only notice it for RE. Is it possible that it takes place in one eye only? I noticed entoptic phenomenon for RE since late Dec 2018 only, could it be due to ERM or other unrelated reasons ? If ERM is removed after surgery, will this entoptic phenomenon disappear?

Thank you
default
Follow up: Dr. N. K. Misra (0 minute later)
Dear Dr Misra,

Thanks much for your reply. Very useful. I have some follow-up questions –
1.     My RE vision is now around 20/30, but I have image distortion if LE is covered up. When using both eyes, I feel unbalanced vision and a bit uneasy. Compared to day 1 when ERM was found (4 weeks ago), I noticed my image distortion has worsened, plus my ERM formed so acutely, does it imply that it will progress quickly?

2.     If I do not do surgery now, will it cause macular hole over time? You mentioned lamellar holes, will it progress to macular hole over time? how long should wait and observe and what examination should I do during the waiting period? Eye examination by doctor or another OCT?

3.     Is the difference between gas injection and no gas injection only on the time taken for recovery, i.e. if I do not inject gas tamponade, my vision will eventually recover and improve to the same extent under the scenario of gas injection but only takes a longer time?

4.     Any cons for gas injection? I heard that gas injection may further accelerate cataract (in addition to the acceleration due to oxidization after vitrectomy)

5.     What is the chance of developing cataract after vitrectomy? I heard that it is up to 60-70 % within the first year of vitrectomy.

6.     For entoptic phenomenon you mentioned, I only notice it for RE. Is it possible that it takes place in one eye only? I noticed entoptic phenomenon for RE since late Dec 2018 only, could it be due to ERM or other unrelated reasons ? If ERM is removed after surgery, will this entoptic phenomenon disappear?

Thank you
doctor
Answered by Dr. N. K. Misra (11 hours later)
Brief Answer:
ERM Surgery

Detailed Answer:
Thank you for your queries.

I will take them one by one:

1. My RE vision is now around 20/30, but I have image distortion if LE is covered up. When using both eyes, I feel unbalanced vision and a bit uneasy. Compared to day 1 when ERM was found (4 weeks ago), I noticed my image distortion has worsened, plus my ERM formed so acutely, does it imply that it will progress quickly?
A. It indeed seems that your ERM is progressing rapidly. As I have mentioned before, apart from your vision, severe distortion in images is another indication for surgery. If you feel significant discomfort, I would suggest surgery for you.


2. If I do not do surgery now, will it cause a macular hole over time? You mentioned lamellar holes, will it progress to the macular hole over time? how long should wait and observe and what examination should I do during the waiting period? Eye examination by a doctor or another OCT?
A. The pathophysiology of Macular holes & Lamellar holes are different, so a lamellar hole will not progress towards a true macular hole.

3. Is the difference between gas injection and no gas injection only on the time is taken for recovery, i.e. if I do not inject gas tamponade, my vision will eventually recover and improve to the same extent under the scenario of gas injection but only takes a long time?
A. Yes, it is mostly the recovery time that is affected. Though some studies have shown that the use of a gas tamponade results in better morphologic outcome although the effect on visual acuity is not significantly different. Better to leave the decision of gas v/s no gas on the operating surgeon. As actual clinical assessment and certain other factors will determine the use of gas.

4. Any cons for gas injection? I heard that gas injection may further accelerate cataract (in addition to the acceleration due to oxidization after vitrectomy)
A. Yes, it might, in certain cases. But, our prime goal should be the best visual outcome.

5. What is the chance of developing a cataract after vitrectomy? I heard that it is up to 60-70 % within the first year of vitrectomy.
A. As I have mentioned before, the cataract will develop eventually.

6. For entoptic phenomenon you mentioned, I only notice it for RE. Is it possible that it takes place in one eye only? I noticed entoptic phenomenon for RE since late Dec 2018 only, could it be due to ERM or other unrelated reasons? If ERM is removed after surgery, will this entoptic phenomenon disappear?
A. It is strange that you are seeing it in only one eye. ERM will usually not lead to a condition like this. I would like to observe this for a while, before coming to a conclusion.

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. N. K. Misra (0 minute later)
Brief Answer:
ERM Surgery

Detailed Answer:
Thank you for your queries.

I will take them one by one:

1. My RE vision is now around 20/30, but I have image distortion if LE is covered up. When using both eyes, I feel unbalanced vision and a bit uneasy. Compared to day 1 when ERM was found (4 weeks ago), I noticed my image distortion has worsened, plus my ERM formed so acutely, does it imply that it will progress quickly?
A. It indeed seems that your ERM is progressing rapidly. As I have mentioned before, apart from your vision, severe distortion in images is another indication for surgery. If you feel significant discomfort, I would suggest surgery for you.


2. If I do not do surgery now, will it cause a macular hole over time? You mentioned lamellar holes, will it progress to the macular hole over time? how long should wait and observe and what examination should I do during the waiting period? Eye examination by a doctor or another OCT?
A. The pathophysiology of Macular holes & Lamellar holes are different, so a lamellar hole will not progress towards a true macular hole.

3. Is the difference between gas injection and no gas injection only on the time is taken for recovery, i.e. if I do not inject gas tamponade, my vision will eventually recover and improve to the same extent under the scenario of gas injection but only takes a long time?
A. Yes, it is mostly the recovery time that is affected. Though some studies have shown that the use of a gas tamponade results in better morphologic outcome although the effect on visual acuity is not significantly different. Better to leave the decision of gas v/s no gas on the operating surgeon. As actual clinical assessment and certain other factors will determine the use of gas.

4. Any cons for gas injection? I heard that gas injection may further accelerate cataract (in addition to the acceleration due to oxidization after vitrectomy)
A. Yes, it might, in certain cases. But, our prime goal should be the best visual outcome.

5. What is the chance of developing a cataract after vitrectomy? I heard that it is up to 60-70 % within the first year of vitrectomy.
A. As I have mentioned before, the cataract will develop eventually.

6. For entoptic phenomenon you mentioned, I only notice it for RE. Is it possible that it takes place in one eye only? I noticed entoptic phenomenon for RE since late Dec 2018 only, could it be due to ERM or other unrelated reasons? If ERM is removed after surgery, will this entoptic phenomenon disappear?
A. It is strange that you are seeing it in only one eye. ERM will usually not lead to a condition like this. I would like to observe this for a while, before coming to a conclusion.

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Chronological events recently - Mid September 2018, sudden appearance of

Chronological events recently - Mid September 2018, sudden appearance of a large floater in RIGHT eye. Eye for examination, no retinal tear or detachment. Doctor said no problem, diagnosis is PVD. - 1 Dec, I saw sudden increase in floaters in LEFT eye. Went to doctor for urgent examination, and found vitreous hemorrhage. Dr said no treatment required, the blood will be gradually absorbed on its own. (I guessed it may be due to a massage done the day prior when area around eye bone below eyebrow and near the nose was pressed hard during massage. But doctor said unlikely ). - Follow up consultation on 8 XXXXXXX 2019. Dr examined both eyes, and found OK. No more blood seen on left eye. Right eye is also fine. - But on 27 XXXXXXX 2019, I suddenly found my vision of RIGHT eye a bit strange, with a wavy dot in central vision. Consulted doctor and found with epirectinal membrane for right eye. Then did OCT on 1 Feb, confirming RIGHT eye ERM. - Seek second opinion on 11 Feb, Dr also advised surgery for RIGHT eye ERM.. Also found a small tear on LEFT eye (ie. the other eye without ERM) and done laser on the same day. Current vision / feeling – - In doing eye examination when seeking second opinion early this week, corrected visual acuity is 20/25. - If I cover up my left eye, I have burred vision and feel like there is a thin layer in front, also stragiht line looks wavy. Sometimes with a light yellowish spot in central vision if background is bright or light colour. If use both my eyes to see, basically OK, but a bit hard when look at computer monitor while reading paper is OK. But sometimes feel the vision of both eyes not very balanced, feel vision a bit unnatural. - First Dr’s medical notes marked down Grade one ERM, striae . Both doctors advised surgery. My OCT report is uploaded - Both doctors said my lens of both eyes are clear, no sign of cataract. - For RIGHT eye, I often see some “branches” images (look very like eye blood vessels images I see when ophthalmologist examines my retina in Indirect ophthalmoscopy) when blinking my eyes, especially when I move from a darker to brighter environment e.g when switch on the light after waking up) My questions 1. I have several eye examinations since Sep 2018 but doctor has not mentioned ERM at all. Everything is fine in 8 XXXXXXX eye examination, but suddenly three weeks later, ERM is found in late XXXXXXX Can ERM be formed so acutely? What is the likely cause in my case? 2. Is at advisable to go for surgery at this stage? Or could I wait and observe for period of time? Will ERM cause macular hole or retinal detachment? 3. I am scared by the risk of surgery. Worried that the process of peeling off the membrane may hurt the retina and cause other complications leading to damage to vision. Can the OCT give any hint on the complexity/risk of the surgery in my case (e.g. size and thickness of the membrane, whether the membrane is very close/connected with the retina making it more difficult for peeling, etc)? 4. The irst doctor said no need to inject gas to eyeball after surgery (thus no need for posture control). But second doctor said yes (need posture control for two days) as this could improve macular edema better and faster. I am confused. Is gas injection necessary? Any possible side effects for gas injection? Could it provide added benefits in my case, while weighing against its potential side effects/risks? 5. First doctor said that cataract will be developed (within about 1st year of surgery) for 70% of patients undergoing such surgery. Why this could lead to cataract? Can anything be done to prevent or delay its occurrence? 6. The first doctor said I can choose complete or partial vitrectomy. Complete vitrectomy lead to cataract faster, partial vitrectomy can delay cataract but I will have some floaters left. But 2nd doctor advised complete vitrectomy. Which option is more advisable? How to choose? What factors to consider? [I am concerned about cataract. If I need to do cataract surgery soon for RIGHT eye after ERM surgery, I will also need to replace my lens of left eye? (because of the great difference between my left eye (with – 850 degree myopia) and my right eye by that time will be myopia corrected after cataract surgery)? I am concerned to have the lens of left eye replaced when it is still clear and function well) 7. Why I see the “branches” images for the right eye when blinking eyes ? Can it be due to the epiretinal memberance? One doctor said it is floaters, and one doctor said it may be the afterimages of eye blodd vessels. I am confused. 8. Any long term complications/risks of other eye diseases (e.g. glaucoma, retinal detachment, macular hole, macular degeneration,etc) after doing the ERM surgery? 9. Is ERM an indicator that I will have higher chance of getting macular diseases like macular hole, age related macular degeneration ?