My father was told he has a wrinkled retina. He is unable to read (everything is blurry). He has been to two eye doctors who told him the surgery is too risky for someone his age (74). He lives out of town. I am becoming frustrated with the situation. Can this situation be rectified?
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Answered by Richard E. Gans, M. D. (xx102@ofcn.org)
From your description, it sounds as though your father has what is called preretinal fibrosis. Over the years, the condition has had several names, including: epiretinal membrane, macular pucker and cellophane maculopathy.
In this condition, there is a fine "cellophane-like" membrane coating the inner surface of the retina, the nerve layer in the back of the eye. This membrane has elastic properties. It tends to contract, causing the retinal surface to wrinkle. This wrinkling results in distorted vision.
There are many potential causes to preretinal fibrosis. It can develop from inflammation within the eye, from circulation problems or from injuries. After an event called a posterior vitreous separation, where the gel filling the center of the eye shrinks, liquefies and separates from the retinal surface, preretinal fibrosis can often develop.
In the majority of cases, the visual impact of these membranes is minor. It has been reported that 75% of people with this condition will maintain vision of better than 20/50. Often, the vision remains surprisingly stable. There is, however, a small percentage of individuals where the vision deteriorates significantly. This is either due to marked distortion of the retinal surface, or because of swelling in the retina, due to an effect of the membrane on the blood vessels in the area.
Surgery is performed to remove these severe membranes when vision is significantly impaired. The procedure, called a vitrectomy, is done to remove and replace the gel within the eye. Then delicate instruments are used to peel the membrane off the surface of the retina.
As you can imagine, this surgery is very delicate and refined. It is recommended only for those individuals who have the potential for a significant improvement in vision after surgery. Often, testing (fluorescein angiography) can be done to determine who might benefit from surgery. Finally, one must be in adequate health to tolerate the anesthetic necessary for the surgery.
The decision as to whether or not any individual should have surgery to correct this must be based upon these criteria and others, coupled with the clinical impression of the retina specialist who would perform the surgery.
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Copyright, 1994. Richard E. Gans, M.D.
A RICHARD E. GANS, M.D. 11
A A OFCN Primary Sysop, The Eye Clinic 111
AAAAA xx102@ofcn.org 11
A A A C A D E M Y O N E 1111
http://www.ofcn.org:80/about.ofcn/whois/reg/
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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