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73-year-old man was seen in the office on May 11, 2011. He has had cataract surgery done in the left eye November 8th. His vision even with glasses is still hazy. He said initially it is better than it was. Initially he noticed problems with things being smaller and things being distorted. He has been on anti-inflammatory drops, Pred Forte and Acular and he notices that is better than it was. Right after the cataract surgery he was still not normal. His right eye has a cataract, but sees pretty well. VISUAL ACUITY: OD 20/30, OS 20/40. IOP: OD 12, OS 13. SLIT EXAMINATION: The right eye has 2+ nuclear sclerosis. The left eye has a posterior chamber intraocular lens in good position. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is posterior vitreous separation with trace epiretinal membrane. OS: Vertical C/D ratio is 0.6. There is a posterior vitreous separation. There is a 2+ epiretinal membrane inferior to the fovea with some dragging of the retinal vessels and the retinal folds associated with it. OCT SCAN: The OCT scan shows an average central foveal thickness in the right eye of 260 microns. The left eye has 408 microns. The right eye does have flattening of the normal foveal pit from the macular pucker and the left eye shows a macular pucker with retinal thickening, predominately inferior to the fovea, but definitely involving the foveal center. There is some loss of the photoreceptor integrity. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows crinkling of the retinal vessels in each eye associated with the macular pucker. In the left eye there is no evidence of leakage in the macula in the late frames nor is there any differential staining of the optic nerve. IMPRESSION: 1. RESOLVED PROBABLE PSEUDOPHAKIC CYSTOID MACULAR EDEMA – LEFT EYE 2. MACULAR PUCKERS – BOTH EYES DISCUSSION: I explained to the patient he does have a macular pucker, worse in the left eye than the right eye. It is adversely affecting his visual acuity and visual function. In his specific situation, I think a reasonable first step would be to taper off the anti-inflammatory drops. I asked him to decrease the Acular and Pred Forte to twice a day for this month and then starting June 1st, to go once a day until he runs out. Some of his visual function might be associated with the two eyes being different and one eye having had cataract surgery and the other eye not. The next thing I think he should do is have the cataract surgery on the fellow eye. If after that his visual function is still bothering him, then it might be reasonable to consider macular pucker surgery. I told him about 80 percent of people improve substantially with macular pucker surgery, but about 10 to 20 percent don’t and there is more risk to the macular pucker surgery than the cataract surgery in his visual acuity range. Sometimes patients do adapt to the macular pucker and don’t need surgery. About ten percent of people in his age group have macular puckers and I assured him the risk of it worsening is extremely low. I asked him to return here for a check in about three months, to see you back in the near future and to return urgently should he notice a problem.

macpucker_mifi01.png
Macular Pucker 20/40 vision and recent cataract surgery155 views 73-year-old man distortion and vision loss since ECCE 6 months ago OS. Patient taking anti-inflammatory drops. VISUAL ACUITY: OD 20/30, OS 20/40.00000
(0 votes)
macpucker_mifi02.png
Macular Pucker 20/40 vision and recent cataract surgery101 views 73-year-old man distortion and vision loss since ECCE 6 months ago OS. Patient taking anti-inflammatory drops. VISUAL ACUITY: OD 20/30, OS 20/40.00000
(0 votes)
macpucker_mifi03.png
Macular Pucker 20/40 vision and recent cataract surgery105 views 73-year-old man distortion and vision loss since ECCE 6 months ago OS. Patient taking anti-inflammatory drops. VISUAL ACUITY: OD 20/30, OS 20/40.00000
(0 votes)
macpucker_mifi04.png
Macular Pucker 20/40 vision and recent cataract surgery76 views 73-year-old man distortion and vision loss since ECCE 6 months ago OS. Patient taking anti-inflammatory drops. VISUAL ACUITY: OD 20/30, OS 20/40.00000
(0 votes)
macpucker_mifi05.png
Macular Pucker 20/40 vision and recent cataract surgery109 views 73-year-old man distortion and vision loss since ECCE 6 months ago OS. Patient taking anti-inflammatory drops. VISUAL ACUITY: OD 20/30, OS 20/40.00000
(0 votes)
macpucker_mifi06.png
Macular Pucker 20/40 vision and recent cataract surgery97 views 73-year-old man distortion and vision loss since ECCE 6 months ago OS. Patient taking anti-inflammatory drops. VISUAL ACUITY: OD 20/30, OS 20/40.00000
(0 votes)
macpucker_mifi07.png
Macular Pucker 20/40 vision and recent cataract surgery67 views 73-year-old man distortion and vision loss since ECCE 6 months ago OS. Patient taking anti-inflammatory drops. VISUAL ACUITY: OD 20/30, OS 20/40.00000
(0 votes)
macpucker_mifi08.png
Macular Pucker 20/40 vision and recent cataract surgery81 views 73-year-old man distortion and vision loss since ECCE 6 months ago OS. Patient taking anti-inflammatory drops. VISUAL ACUITY: OD 20/30, OS 20/40.00000
(0 votes)
macpucker_mifi09.png
Macular Pucker 20/40 vision and recent cataract surgery101 views 73-year-old man distortion and vision loss since ECCE 6 months ago OS. Patient taking anti-inflammatory drops. VISUAL ACUITY: OD 20/30, OS 20/40.00000
(0 votes)
macpucker_mifi10.png
Macular Pucker 20/40 vision and recent cataract surgery101 views 73-year-old man distortion and vision loss since ECCE 6 months ago OS. Patient taking anti-inflammatory drops. VISUAL ACUITY: OD 20/30, OS 20/40.00000
(0 votes)
macpucker_mifi11.jpg
Macular Pucker 20/40 vision and recent cataract surgery134 views 73-year-old man distortion and vision loss since ECCE 6 months ago OS. Patient taking anti-inflammatory drops. VISUAL ACUITY: OD 20/30, OS 20/40.00000
(0 votes)
macpucker_mifi12.jpg
Macular Pucker 20/40 vision and recent cataract surgery155 views 73-year-old man distortion and vision loss since ECCE 6 months ago OS. Patient taking anti-inflammatory drops. VISUAL ACUITY: OD 20/30, OS 20/40.00000
(0 votes)
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73-year-old man was seen in the office on May 11, 2011. He has had cataract surgery done in the left eye November 8th. His vision even with glasses is still hazy. He said initially it is better than it was. Initially he noticed problems with things being smaller and things being distorted. He has been on anti-inflammatory drops, Pred Forte and Acular and he notices that is better than it was. Right after the cataract surgery he was still not normal. His right eye has a cataract, but sees pretty well. VISUAL ACUITY: OD 20/30, OS 20/40. IOP: OD 12, OS 13. SLIT EXAMINATION: The right eye has 2+ nuclear sclerosis. The left eye has a posterior chamber intraocular lens in good position. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.5. There is posterior vitreous separation with trace epiretinal membrane. OS: Vertical C/D ratio is 0.6. There is a posterior vitreous separation. There is a 2+ epiretinal membrane inferior to the fovea with some dragging of the retinal vessels and the retinal folds associated with it. OCT SCAN: The OCT scan shows an average central foveal thickness in the right eye of 260 microns. The left eye has 408 microns. The right eye does have flattening of the normal foveal pit from the macular pucker and the left eye shows a macular pucker with retinal thickening, predominately inferior to the fovea, but definitely involving the foveal center. There is some loss of the photoreceptor integrity. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows crinkling of the retinal vessels in each eye associated with the macular pucker. In the left eye there is no evidence of leakage in the macula in the late frames nor is there any differential staining of the optic nerve. IMPRESSION: 1. RESOLVED PROBABLE PSEUDOPHAKIC CYSTOID MACULAR EDEMA – LEFT EYE 2. MACULAR PUCKERS – BOTH EYES DISCUSSION: I explained to the patient he does have a macular pucker, worse in the left eye than the right eye. It is adversely affecting his visual acuity and visual function. In his specific situation, I think a reasonable first step would be to taper off the anti-inflammatory drops. I asked him to decrease the Acular and Pred Forte to twice a day for this month and then starting June 1st, to go once a day until he runs out. Some of his visual function might be associated with the two eyes being different and one eye having had cataract surgery and the other eye not. The next thing I think he should do is have the cataract surgery on the fellow eye. If after that his visual function is still bothering him, then it might be reasonable to consider macular pucker surgery. I told him about 80 percent of people improve substantially with macular pucker surgery, but about 10 to 20 percent don’t and there is more risk to the macular pucker surgery than the cataract surgery in his visual acuity range. Sometimes patients do adapt to the macular pucker and don’t need surgery. About ten percent of people in his age group have macular puckers and I assured him the risk of it worsening is extremely low. I asked him to return here for a check in about three months, to see you back in the near future and to return urgently should he notice a problem.