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Is ERM (Epi Retinal Membrane) peel post-op confirmation possible?
This may seem like a strange question, but I recently had a vitrectomy procedure to peel my ERM. The surgeon said the procedure went well, and saw me the day after the procedure, a week after and a month after. At the 1 month follow up, he said from the scan my CME condition has worsen instead of improving and he is unsure what the next step should be. He suggested I make an appointment with another retinal specialist at the same office to get a second opinion. So I did, his partner after seeing me and looking at the scan said two possibilities, there are some medications/injections to try but they are not approved for use in the USA but I can appeal to the insurance, or do the membrane peel again but this time peel "more of it". I asked how much was peeled before and how much would he recommend to peel, he said just a larger area for the peel.
It seems this is going nowhere I made an appointment to see a third retinal specialist not in the same office. That specialist did the OCT scans and he also saw my pre-op scans which I had with me, and he said your epiretinal membrane is still there. I said it was peeled 5 weeks ago he said no it wasn't, it is clearly still there, what exactly did your surgeon do? You need to go back and confirm with him about the procedure. I was shocked. How is it possible for me to have a procedure to peel the membrane yet it wasn't peeled. Unconvinced and confused I went to see a forth retinal specialist and he also said looks like my ERM is still there, and suggested I may be confused and had a different procedure, he checked my left eye to make sure they didn't peel the wrong eye's membrane, but I knew it was the right eye because I was awake during the procedure, but again, this doctor said he really couldn't help me because I am still in the post operative state of this surgery I need to go back and get clarity on what was done to me.
I then booked an appointment with the original retinal specialist who operated on me. I asked if the procedure to peel the membrane was there any complications during the procedure like the membrane was very adherent making peeling difficult or impossible? He said no it went fine. I asked is it possible for the membrane to grow back after a month he said no not possible. I then told him I saw two other specialists and they said my ERM is still there and I don't understand. His answer was there are two membranes, the top one and one right under it (I think it's called the ILM Internal Limiting Membrane) and the OCT scan still shows a membrane is the ILM, and he said it is not possible to tell the ERM and ILM apart on the scan and he said I may consider doing another procedure to peel the ILM but there is no guarantee this will solve my issue.
So now I am totally confused. Was my ERM peeled as my surgeon stated, or is it still there as the other two retinal specialist said?
Is it possible to see from the OCT scans if my ERM has been peeled? This is so disappointing and confusing I don't know what to believe.
I have the scans and can post pictures if needed, or if there is an expert on this who I can contact for a definitive answer that would be very helpful too.
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I had an ERM peel. I was awake during surgery and could see it being peeled off. You could tell it was removed from the scan. I had cataract surgery just before that. Between the two surgeries I developed CME. Now I have inflammation in that retina which was being treated by steroids, but I developed steroid response glaucoma that couldn't be controlled, so now this eye is a mess. This result seems to be pretty rare, but there wasn't any ambiguity about the membrane. You can see a little of the remaining edges of it on my OTC scans
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1 ReactionI have an ERM that I will probably be having surgery on in September or October. If I were you I would be seeking an opinion from a surgeon or group at a large academic medical center, or definitely someplace with a great deal of experience with these procedures. It is apparent there is a complication or problem of some type with your eye. You also know you DID have surgery on that eye, and you need someone who recognizes this and knows how to proceed safely and successfully going forward
@mikena the issue is quite complicated because it appears to be more than just medicine.
Because I recently had surgery in that eye, other surgeons are reluctant to take me on to further the treatment, they said since I am still in the post operative state of that procedure I must go back to my original surgeon.
Regarding why I had a membrane peel surgery but the membrane is still there - according to the two specialists I saw, they feel as though I must have had a misunderstanding of what procedure I had, or may be my surgeon didn't proceed with the plan due to something he saw, and I need to go back to get clarity from my surgeon. Yet my surgeon said my membrane was peeled and there was no complication.
I got a copy of my surgery notes, and there are very detailed descriptions in there but no mention of peeling anything.
So the issue is yes, I probably need a fresh start with another surgeon and proceed from there, but then again, the fresh start must start from somewhere, and if someone is able and willing to take me on, he will need to see my doctor's notes and everything that has happened up till this point, but what is being disputed is did my membrane get peeled? According to two specialists the scans say NO, according to my surgeon yes it happened without complications. I have to find the answer and I am not sure where to get it. This is the reason for the post. Is it possible some research expert can review my scans - I have scans 3 weeks before surgery and 1 week post op and tell me definitively where I stand.
how bad was your vision to decide on peeling the membrane. my surgeon is telling me to leave mine alone and watch it every 6 to 9 months. my right eye (with the membrane, doesn't focus with the other eye for up close things like reading. at a distance its useable. it's true there are two layers. Also, how long did you have the membrane before the surgery? Good luck.
I feel sorry to hear such stories,I have my own!
After I had the EPI Retinal surgery,membrane removed,I’ve been left with double vision ,still going after two years since surgery.
When I had post op consultation ( one week after surgery) I’ve been assured by the surgeon that is going to disappear after one week.
I had it for two years now,very frustrating!
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1 Reaction@ion have the optometrist do glasses with a prism. My vision doesn't line up eye to eye either.
@miamicuse1960 sorry to hear of your issues. I would definitely continue to get other medical opinions. Lately I have been googling a question and continue using AI for further help with questions. The last issues I dealt with aligned with everything I had done. So it seemed helpful. I will share with you, I have sat in a room with many physicians to discuss a case with a particular problem and they will have different opinions and treatments. AI will be very useful in the future to take a problem and combine diagnosis and treatments. Keep at it. Prayers help too.
In replay to @margieb58
Thank you,I have them,help me for aprox , 2 hours,after that the double vision is back,I have to close one eye to be able to read properly.
I’ve seen few specialists,different opinions,nothing helpful!
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1 ReactionMy eyes also tend to vary on how well the prism is aligned with what they want at a particular time. However, the right eye threw the biggest hissy fit after 2 surgeries (cataract and ERM removal) that the vision in that eye is always a mess. We had to drop the steroids that controlled it due to steroid induced glaucoma. Tried glaucoma drugs and they couldn't control it. The biggest unexpected mess. None of this was in the risk factors I saw. Right now, I am preserving the optic nerve which is still healthy and waiting for a better solution to come along. I think it is so rare that not much has been investing in fixing it.
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1 Reactionwhat do you tell your optomitrist to get prism. my epi membrane causes me not to be able to use both eyes for close things like reading. i was told by retinal surgeons that glasses won't fix it -- it's your brain not being able to blend the images from both eyes. I would like to ask about prism lenses if they would actually help. My optomitrist has never suggested them or spoke about it.