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Dear Dr Misra Thanks For Your Advice In My Earlier
Question: Dear Dr Misra
Thanks for your advice in my earlier thread
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=397427
My doctor suggested that for my left eye, I can consider to do ERM surgery and cataract surgery at the same time, saving another surgery (ie. cataract surgery) not long after ERM surgery.
I want to know the pros and cons of doing both surgery at the same time vs the pros and cons of doing the surgery separately.
My thinking (but not know it is right or not)
1. if I do both ERM and cataract surgeries at the same time, if there are post surgery issues (e.g. vision not clear, other discomfort/problems etc. ) it may be difficult to assess whether it is due to ERM or cataract surgeries.
2. If I do ERM first, after a certain period for recovery with my vision and my retina conditions becoming more stable, I can prepare better for cataract surgery (e.g. more accurate in doctor’s calculations in deciding the IOL before cataract surgery)
Dr Misra, if my thinking above is correct, I would prefer doing ERM surgery first, to be followed by cataract surgery when cataract arise. I do not mind having two surgeries, one at different time.
On the other hand, if doing ERM surgery first and then cataract surgery later will yield higher risk for the latter, it may be worthwhile to do two surgeries in one go.
Dr Misra, could you advise the pros and cons of these two options (ie. doing both surgery at the same time vs doing the surgeries separately)? Which option do you recommend?
Wish to receive your expert advice soon. Thanks much
Thanks for your advice in my earlier thread
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=397427
My doctor suggested that for my left eye, I can consider to do ERM surgery and cataract surgery at the same time, saving another surgery (ie. cataract surgery) not long after ERM surgery.
I want to know the pros and cons of doing both surgery at the same time vs the pros and cons of doing the surgery separately.
My thinking (but not know it is right or not)
1. if I do both ERM and cataract surgeries at the same time, if there are post surgery issues (e.g. vision not clear, other discomfort/problems etc. ) it may be difficult to assess whether it is due to ERM or cataract surgeries.
2. If I do ERM first, after a certain period for recovery with my vision and my retina conditions becoming more stable, I can prepare better for cataract surgery (e.g. more accurate in doctor’s calculations in deciding the IOL before cataract surgery)
Dr Misra, if my thinking above is correct, I would prefer doing ERM surgery first, to be followed by cataract surgery when cataract arise. I do not mind having two surgeries, one at different time.
On the other hand, if doing ERM surgery first and then cataract surgery later will yield higher risk for the latter, it may be worthwhile to do two surgeries in one go.
Dr Misra, could you advise the pros and cons of these two options (ie. doing both surgery at the same time vs doing the surgeries separately)? Which option do you recommend?
Wish to receive your expert advice soon. Thanks much
Brief Answer:
ERM
Detailed Answer:
My dear,
Thanks for getting back to me.
There are basically two issues,having both surgeries togather,has its own set of problems.Having two surgeries separately has advantages of waiting for cataract to develop reasonably to go in for cataract surgery at suitable time.
I have had personal issues with my patients about deciding for surgery where cataract surgery was not called for.I feel the patient has to earn his surgery.The cataract surgery has to be justified.
If there is just a trace of cataract,which is not interfering with vision then a unnecessary procedure is to be avoided.
ERM peeling is a more traumatic procedure while cataract is a comferably doable procedure with reasonably happy outcome.
I would prefer a two stage strategy,where second stage time is justified
ERM
Detailed Answer:
My dear,
Thanks for getting back to me.
There are basically two issues,having both surgeries togather,has its own set of problems.Having two surgeries separately has advantages of waiting for cataract to develop reasonably to go in for cataract surgery at suitable time.
I have had personal issues with my patients about deciding for surgery where cataract surgery was not called for.I feel the patient has to earn his surgery.The cataract surgery has to be justified.
If there is just a trace of cataract,which is not interfering with vision then a unnecessary procedure is to be avoided.
ERM peeling is a more traumatic procedure while cataract is a comferably doable procedure with reasonably happy outcome.
I would prefer a two stage strategy,where second stage time is justified
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Dr. Misra,
Thanks much for your advice. You said that having both surgeries (ERM and cataract) togather has its own set of problems. Could you please elaboarate a bit?
On the other hand, for the two-stage strategy you suggested, will there be any potential problem/complication for performing cataract surgery separately (e.g. as my vitreous body is removed after ERM surgery, will this have any impact on cataract surgery? e.g. make the positioning of IOL during surgery less precise).
Thank again for your expert advice so that I could make informed decision.
Thanks much for your advice. You said that having both surgeries (ERM and cataract) togather has its own set of problems. Could you please elaboarate a bit?
On the other hand, for the two-stage strategy you suggested, will there be any potential problem/complication for performing cataract surgery separately (e.g. as my vitreous body is removed after ERM surgery, will this have any impact on cataract surgery? e.g. make the positioning of IOL during surgery less precise).
Thank again for your expert advice so that I could make informed decision.
Brief Answer:
Membrane peeling and iol surgery.
Detailed Answer:
My dear,
Thanks for getting back to me.
Removal of vitreous body ,vitrectomy,is done by making two or three holes in the eye, depending upon surgeon's preference.During making of these holes,there is slight bleeding,which has to stop before one proceeds further for vitrectomy.In performing cataract surgery simultaneously,there are entirely different three holes which are to be made all over again,these three new holes have no relation with three ports for vitrectomy.
In your case the two steps do not have to be taken up togather.I feel after erm peeling,one waits for cataract to start creating problem,then cataract surgery is justified.
I have probably burdened you with surgical steps ,but that background is necessary to have a clear picture in mind.
This becomes a surgeon's personal choice,to do two surgeries togather or separately.
IoL placement has no issues with vitrectomised eyes.They are separate set of instruments and different set of procedure and done separately,even in one sitting .Though it has the advantage of avoiding one visit to OT.
Membrane peeling and iol surgery.
Detailed Answer:
My dear,
Thanks for getting back to me.
Removal of vitreous body ,vitrectomy,is done by making two or three holes in the eye, depending upon surgeon's preference.During making of these holes,there is slight bleeding,which has to stop before one proceeds further for vitrectomy.In performing cataract surgery simultaneously,there are entirely different three holes which are to be made all over again,these three new holes have no relation with three ports for vitrectomy.
In your case the two steps do not have to be taken up togather.I feel after erm peeling,one waits for cataract to start creating problem,then cataract surgery is justified.
I have probably burdened you with surgical steps ,but that background is necessary to have a clear picture in mind.
This becomes a surgeon's personal choice,to do two surgeries togather or separately.
IoL placement has no issues with vitrectomised eyes.They are separate set of instruments and different set of procedure and done separately,even in one sitting .Though it has the advantage of avoiding one visit to OT.
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Above answer was peer-reviewed by :
Dr. Nagamani Ng
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