Question: Dear Dr Misra,
Thanks for your answer in the thread https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=391899

I have done my right eye ERM surgery for over 4 months. In my recent checkup, my doctor said still has slight macular edema, but he thought will continue to improve. He noticed trace cataract. For my left eye, Dr said is Grade 1 -2 ERM, it has deterioriated with fovea thickness from 318 in early XXXXXXX to 386 in late September (OCT reports attached). Doctor advised to consider surgery for LE, as the earlier the surgery, the better the result because the longer I delay the surgery, the more photoreptor cells will die.

Latest VA - RE 20/20-, LE 20/20+

My feeling is that RE is recovering quite well, but I still have mild distortion, especially when viewing computers. For LE, VA is still good, but have unbalanced feeling when use both my eyes together and sometimes with double images


My questions
1.     What do you think about my surgery results for RE? Now it is about 4 months after my surgery in end May, still with mild macular edema is common? Can I expect further improvement? If so, when will improvement stop?

2.     Dr said the emergent cataract for my RE is earlier than expected. Is such early emergency uncommon for vitrectomy patients? With trace cataract noticed, what will be the pace of development ? (I think must be faster than normal people without vitrectomy done) (Expect need to replace the lens within a few month, 1 year or can be longer?


3.     I asked my doctor any prime time for ERM surgery and he said no. I then asked how long photoreceptor cells will die if leave untreated, but he has not directly answered and said the cells are dying because I get the disease now (seems suggested that my ERM is active now, and so my cells are somehow being damaged)

Dr Misra, is it true that there is no prime period for surgery? Any reference indicators for surgery or urgency of surgery. My VA is still good currently, and the LE vison distortion is not that bothersome as compared to the past situation for my RE. But the imbalance feeling when using two eyes is getting slightly worse. I would like to oberve for LE for some time, what do you think?

What is your advice to me based on your clinical experience? Is fovea thickness a good indicator to guide us in deciding whether to observe or to proceed with surgery? Say, would it suggest greater urgency for surgery if fovea thickness rises to say 500 or more?

Is the imbalance feeling due to edema in left eye?


4.     I have resumed work for more than a month, my eyes (both right and left eye) still get tired easily, especially after using computer for a while and I have to use lubricant about once an hour. Will persistent eye strain and dryness cause do harm or cause/trigger other eye diseases in the long run? I also wonder whether frequent use of lubricant/artificial tear will do any harm to the eye in the long run?

Grateful for your expert advice

Dear Dr Misra,
Thanks for your answer in the thread https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=391899

I have done my right eye ERM surgery for over 4 months. In my recent checkup, my doctor said still has slight macular edema, but he thought will continue to improve. He noticed trace cataract. For my left eye, Dr said is Grade 1 -2 ERM, it has deterioriated with fovea thickness from 318 in early XXXXXXX to 386 in late September (OCT reports attached). Doctor advised to consider surgery for LE, as the earlier the surgery, the better the result because the longer I delay the surgery, the more photoreptor cells will die.

Latest VA - RE 20/20-, LE 20/20+

My feeling is that RE is recovering quite well, but I still have mild distortion, especially when viewing computers. For LE, VA is still good, but have unbalanced feeling when use both my eyes together and sometimes with double images


My questions
1.     What do you think about my surgery results for RE? Now it is about 4 months after my surgery in end May, still with mild macular edema is common? Can I expect further improvement? If so, when will improvement stop?

2.     Dr said the emergent cataract for my RE is earlier than expected. Is such early emergency uncommon for vitrectomy patients? With trace cataract noticed, what will be the pace of development ? (I think must be faster than normal people without vitrectomy done) (Expect need to replace the lens within a few month, 1 year or can be longer?


3.     I asked my doctor any prime time for ERM surgery and he said no. I then asked how long photoreceptor cells will die if leave untreated, but he has not directly answered and said the cells are dying because I get the disease now (seems suggested that my ERM is active now, and so my cells are somehow being damaged)

Dr Misra, is it true that there is no prime period for surgery? Any reference indicators for surgery or urgency of surgery. My VA is still good currently, and the LE vison distortion is not that bothersome as compared to the past situation for my RE. But the imbalance feeling when using two eyes is getting slightly worse. I would like to oberve for LE for some time, what do you think?

What is your advice to me based on your clinical experience? Is fovea thickness a good indicator to guide us in deciding whether to observe or to proceed with surgery? Say, would it suggest greater urgency for surgery if fovea thickness rises to say 500 or more?

Is the imbalance feeling due to edema in left eye?


4.     I have resumed work for more than a month, my eyes (both right and left eye) still get tired easily, especially after using computer for a while and I have to use lubricant about once an hour. Will persistent eye strain and dryness cause do harm or cause/trigger other eye diseases in the long run? I also wonder whether frequent use of lubricant/artificial tear will do any harm to the eye in the long run?

Grateful for your expert advice

Dear Dr Mistra,

Thanks much for your prompt reply. You always provide useful advice.

How about your advice on the ERM issue of my unoperated left eye? re. my question 2 above

Dear Dr Mistra,

Thanks much for your prompt reply. You always provide useful advice.

How about your advice on the ERM issue of my unoperated left eye? re. my question 2 above

Thanks Dr Misra,

Can you tell more about nepafenac 3% eye drop? How this drug could help ERM? My doctors have never mentioned about this drug and how it could help ERM since ERM was found in my RE (which has been operated then). Now LE also has ERM, my doctors also only mentioned about surgery.

In my LE case (you may refer to the OCT reports I uploaded earlier), do you mean that I can try nepafenac first before surgery? Can it help relieve fovea changes and if so in what ways?

I have heard from health programme that the golder period for ERM surgey is within half to one year, to yield the best results. Is this true?

Would appreciate further explanation and advice

Thanks Dr Misra,

Can you tell more about nepafenac 3% eye drop? How this drug could help ERM? My doctors have never mentioned about this drug and how it could help ERM since ERM was found in my RE (which has been operated then). Now LE also has ERM, my doctors also only mentioned about surgery.

In my LE case (you may refer to the OCT reports I uploaded earlier), do you mean that I can try nepafenac first before surgery? Can it help relieve fovea changes and if so in what ways?

I have heard from health programme that the golder period for ERM surgey is within half to one year, to yield the best results. Is this true?

Would appreciate further explanation and advice

Thanks Dr Misra. Do you mean that ERM may be an inflammatory response and so using nepafenac may help? Will nepafenace help to slow down the ERM progression or it can even help to reverse the condition such as the membrane removed/resolved on its own?

Thanks Dr Misra. Do you mean that ERM may be an inflammatory response and so using nepafenac may help? Will nepafenace help to slow down the ERM progression or it can even help to reverse the condition such as the membrane removed/resolved on its own?