Question: Dear Dr Harshita,

I have been diagnosed right eye epiretinal membrane in early Feb this year and has progressed quite rapidly. My first and latest OCT uploaded. My vision is now 20/40. I will soon proceed to surgery. I have some questions and wish to seek further expert advice –

1. What is the extent of severity of my ERM? The fovea thickness has increase from 333 to 397 within just 2 months. What is / are the reasons for such rapid progress? Can you tell whether my case is simple or complicated for surgery? With rapid progression, I am concerned about the possible complications for surgery.

2.      I have consulted two doctors. The first one said I can choose complete or partial vitrectomy. He said complete vitrectomy lead to cataract faster, partial vitrectomy can delay cataract but I will have some floaters left. But 2nd doctor advised complete vitrectomy. Which option is more advisable? How to choose? What factors to consider?

3.      What are other pros and cons of complete vitrectomy vs partial vitrectomy? My doctor said complete vitrectomy may lead to increase in intraocular pressure in the longer term? Is this risk lower if I choose partial vitrectomy?

4.     Do I have edema based on OCT? One doctor said no while the other said a bit. I am confused.

5. For the prognosis after surgery, what is the extent of improvement can I expect over time, in terms of improvement in metamorphopsia and visual acuity respectively?Will my vision be worse than before surgery in the initial period right after surgery? When will I start to see notable improvement in vision ?

6. Besides accelerated cataract, any long term complications/risks of other eye diseases (e.g. glaucoma, retinal detachment, macular hole, macular degeneration or other eye disease) after doing the ERM surgery?

I am indeed worried about the risk and possible complications of surgery and prognosis. Thanks in advance for your expert advice.

Dear Dr Harshita,

I have been diagnosed right eye epiretinal membrane in early Feb this year and has progressed quite rapidly. My first and latest OCT uploaded. My vision is now 20/40. I will soon proceed to surgery. I have some questions and wish to seek further expert advice –

1. What is the extent of severity of my ERM? The fovea thickness has increase from 333 to 397 within just 2 months. What is / are the reasons for such rapid progress? Can you tell whether my case is simple or complicated for surgery? With rapid progression, I am concerned about the possible complications for surgery.

2.      I have consulted two doctors. The first one said I can choose complete or partial vitrectomy. He said complete vitrectomy lead to cataract faster, partial vitrectomy can delay cataract but I will have some floaters left. But 2nd doctor advised complete vitrectomy. Which option is more advisable? How to choose? What factors to consider?

3.      What are other pros and cons of complete vitrectomy vs partial vitrectomy? My doctor said complete vitrectomy may lead to increase in intraocular pressure in the longer term? Is this risk lower if I choose partial vitrectomy?

4.     Do I have edema based on OCT? One doctor said no while the other said a bit. I am confused.

5. For the prognosis after surgery, what is the extent of improvement can I expect over time, in terms of improvement in metamorphopsia and visual acuity respectively?Will my vision be worse than before surgery in the initial period right after surgery? When will I start to see notable improvement in vision ?

6. Besides accelerated cataract, any long term complications/risks of other eye diseases (e.g. glaucoma, retinal detachment, macular hole, macular degeneration or other eye disease) after doing the ERM surgery?

I am indeed worried about the risk and possible complications of surgery and prognosis. Thanks in advance for your expert advice.

Thanks for your reply Dr. Harshita

The two OCT were done on the same machine. While my RE vision is not too bad but the problem of metamorphopsia affect my daily life and work. I feel my RE and LE vision unbalanced and not aligned and this makes me feel uneasy and unnatural. The feeling is somewhat like you are not wearing a proper nearsightedness glasses with great differences between LE and RE. Sometimes I feel somewhat like double vision for some images.

I have some further questions and grateful for your advice-

1.     You said “in a simple ERM we usually do partial vitrectomy and leave the peripheral part as ERM is in the central area only .” But is there a risk that the peripheral vitreous left behind will increase the risk of retinal tear and detachment?

2.     I understand that complete vitrectomy accelerate cataract faster than partial vitrectomy. Apart from this, are there other cons of complete vitrectomy compared to partial vitrectomy? What would you advise, complete vs partial vitrectomy, weighing benefits and risks?

3.     My doctor said no need to inject gas in my case, and not injecting gas will not affect my recovery. Is gas injection necessary for mild ERM?

4.     How much improvement in visual acuity can I expect after surgery ? As regards metamorphopsia, unbalanced and unaligned vision of RE and LE I am experiencing, can I expect substantial improvement after surgery? Can you share your clinical experience?

5.     You mentioned “in every high myopia case we have a risk of retinal detachment and glaucoma but perse due to surgery the risk of these are very low .” Do you mean the the risk of retinal detachment and glaucoma due to ERM surgery is very low. Only that the risk is due to high myopia, regardless having ERM surgery or not?

6.     My understanding is that ERM will not resolve on its own and surgery is the only way to cure it. Also the longer I wait, the thicker the membrane will grow and it will be more difficult to peel off the membrane and may lead to more complications in surgery. Am I correct? If so, my thinking is that since I already have symptoms affecting my vision and my life, in particular my work, I chose to do surgery now. Any advice or points for me to note?

7.     For care after surgery, I understand that one complication is infection and so I need to take good care to avoid infection. What specific things I should do or not do after surgery, especially those things that we will easily overlook? What other care do I need to take after surgery? What should I pay attention to?

Thanks again in advance for your expert advice

Thanks for your reply Dr. Harshita

The two OCT were done on the same machine. While my RE vision is not too bad but the problem of metamorphopsia affect my daily life and work. I feel my RE and LE vision unbalanced and not aligned and this makes me feel uneasy and unnatural. The feeling is somewhat like you are not wearing a proper nearsightedness glasses with great differences between LE and RE. Sometimes I feel somewhat like double vision for some images.

I have some further questions and grateful for your advice-

1.     You said “in a simple ERM we usually do partial vitrectomy and leave the peripheral part as ERM is in the central area only .” But is there a risk that the peripheral vitreous left behind will increase the risk of retinal tear and detachment?

2.     I understand that complete vitrectomy accelerate cataract faster than partial vitrectomy. Apart from this, are there other cons of complete vitrectomy compared to partial vitrectomy? What would you advise, complete vs partial vitrectomy, weighing benefits and risks?

3.     My doctor said no need to inject gas in my case, and not injecting gas will not affect my recovery. Is gas injection necessary for mild ERM?

4.     How much improvement in visual acuity can I expect after surgery ? As regards metamorphopsia, unbalanced and unaligned vision of RE and LE I am experiencing, can I expect substantial improvement after surgery? Can you share your clinical experience?

5.     You mentioned “in every high myopia case we have a risk of retinal detachment and glaucoma but perse due to surgery the risk of these are very low .” Do you mean the the risk of retinal detachment and glaucoma due to ERM surgery is very low. Only that the risk is due to high myopia, regardless having ERM surgery or not?

6.     My understanding is that ERM will not resolve on its own and surgery is the only way to cure it. Also the longer I wait, the thicker the membrane will grow and it will be more difficult to peel off the membrane and may lead to more complications in surgery. Am I correct? If so, my thinking is that since I already have symptoms affecting my vision and my life, in particular my work, I chose to do surgery now. Any advice or points for me to note?

7.     For care after surgery, I understand that one complication is infection and so I need to take good care to avoid infection. What specific things I should do or not do after surgery, especially those things that we will easily overlook? What other care do I need to take after surgery? What should I pay attention to?

Thanks again in advance for your expert advice

Thanks Dr for your prompt reply.

i just got flu and bronchitis. , have cough, now on antibiotics. my erm surgery will take place on 23 april ie two days later. General anesthesia.

I wonder if i am suitable to proceed to surger given my physical conditions. Will there be increased risk?

Is it advisable to postpone my surgery?

I am also concerned if i will have an increased risk of infection to my surgery eye.

May i have your expert advice .

Thanks Dr for your prompt reply.

i just got flu and bronchitis. , have cough, now on antibiotics. my erm surgery will take place on 23 april ie two days later. General anesthesia.

I wonder if i am suitable to proceed to surger given my physical conditions. Will there be increased risk?

Is it advisable to postpone my surgery?

I am also concerned if i will have an increased risk of infection to my surgery eye.

May i have your expert advice .

Thanks Dr.

You said "you wont be able to take general anesthesia if you have flu .". What are the particular concerns?

I am getting better now. if my cough stops on surgery day. is it still advisable to postpone surgery? If postpone, should I wait until I have fully recovered from flu and bronchitis?

Also, what are the risks if I proceed with the eye surgery if I have not fully recovered?


Appreciate your expert advice

Thanks Dr.

You said "you wont be able to take general anesthesia if you have flu .". What are the particular concerns?

I am getting better now. if my cough stops on surgery day. is it still advisable to postpone surgery? If postpone, should I wait until I have fully recovered from flu and bronchitis?

Also, what are the risks if I proceed with the eye surgery if I have not fully recovered?


Appreciate your expert advice

Thanks Dr Marshita for your prompt reply. Wish to clarify some points -

1.     You said we dont usually operate as then there is always risk of infection spreading. Does it mean that there is a risk of infecting my surgery eye, during the surgery or post-surgery? If so, the consequences could be disastrous?

2.     If I still have mild cough when doing surgery, under general anesthesia, will I cough involuntarily? If I get better but still have mild cough or sore throat only, should still postpone surgery until full recovery?

3.     You advise me to clear the respiratory tract infection first. Do you mean that even if my cough has subsided, if my respiratory tract infection still exist, I should postpone my surgery? How to ensure my respiratory tract infection is cleared?

4.     I am now on antibiotics for two days and my GP will probably prescribe 2 – 3 days more antibiotics, which means that I am still taking antibiotics on the day of my surgery. From your experience, is it more safe to postpone my surgery until I have completed the antibiotics course?

5.     I am weighing the risks and benefits of proceeding with surgery. My thinking is that if the consequences of the risks of going ahead with surgery as scheduled could be very severe, I dare not bear the risks. Any advice? If I postpone for one to two weeks, do you think my ERM will become worse given my rapid progression in just two moths.

6.     A separate issue, can you tell from my earlier OCT whether my ERM is a simple or complicated case? I worry about possible complications for my surgery.


Many thanks again for your advice

Thanks Dr Marshita for your prompt reply. Wish to clarify some points -

1.     You said we dont usually operate as then there is always risk of infection spreading. Does it mean that there is a risk of infecting my surgery eye, during the surgery or post-surgery? If so, the consequences could be disastrous?

2.     If I still have mild cough when doing surgery, under general anesthesia, will I cough involuntarily? If I get better but still have mild cough or sore throat only, should still postpone surgery until full recovery?

3.     You advise me to clear the respiratory tract infection first. Do you mean that even if my cough has subsided, if my respiratory tract infection still exist, I should postpone my surgery? How to ensure my respiratory tract infection is cleared?

4.     I am now on antibiotics for two days and my GP will probably prescribe 2 – 3 days more antibiotics, which means that I am still taking antibiotics on the day of my surgery. From your experience, is it more safe to postpone my surgery until I have completed the antibiotics course?

5.     I am weighing the risks and benefits of proceeding with surgery. My thinking is that if the consequences of the risks of going ahead with surgery as scheduled could be very severe, I dare not bear the risks. Any advice? If I postpone for one to two weeks, do you think my ERM will become worse given my rapid progression in just two moths.

6.     A separate issue, can you tell from my earlier OCT whether my ERM is a simple or complicated case? I worry about possible complications for my surgery.


Many thanks again for your advice

Dear Dr Harshita,

Thanks for your advice. I have rescheduled the surgery to two weeks later. I am concerned that further delay would make my ERM worse, causing more complications to the surgery and poorer outcome. My questions/queries –

1.     Do you think 2 weeks is sufficient for clearing my infection and proceed to surgery?

2.     From my latest OCT report done in end March, lamellar holes can been seen. Will prolonged ERM lead to macular hole or retinal detachment?

3.     Given my rapid progression from early February to end March comparing the two OCT, I am worried that further delay would cause more complications to my surgery and post surgery recovery. Any advice

4.     You ealier said that my ERM is a simple one but my eye is myopic . The ERM doesnt make it a complicated case at all but myopia does . Could you explain a bit why myopic eye causes complications?

5.     My current vision is about 20/40, what is the expected improvement after surgery?

May I have your advice and can you share your experience? Many thanks in advance

Dear Dr Harshita,

Thanks for your advice. I have rescheduled the surgery to two weeks later. I am concerned that further delay would make my ERM worse, causing more complications to the surgery and poorer outcome. My questions/queries –

1.     Do you think 2 weeks is sufficient for clearing my infection and proceed to surgery?

2.     From my latest OCT report done in end March, lamellar holes can been seen. Will prolonged ERM lead to macular hole or retinal detachment?

3.     Given my rapid progression from early February to end March comparing the two OCT, I am worried that further delay would cause more complications to my surgery and post surgery recovery. Any advice

4.     You ealier said that my ERM is a simple one but my eye is myopic . The ERM doesnt make it a complicated case at all but myopia does . Could you explain a bit why myopic eye causes complications?

5.     My current vision is about 20/40, what is the expected improvement after surgery?

May I have your advice and can you share your experience? Many thanks in advance

Dear Dr Harshita,

Apart from the above queries, I have one more question. I now have bronchitis and severe cough in these few days. Wonder whether severe cough would cause my ERM to progress to macular hole or even retinal detachement?

I do not want to have further complications to my eye conditions during this healing period for my flu and bronchitis.

Thanks for your advice

Dear Dr Harshita,

Apart from the above queries, I have one more question. I now have bronchitis and severe cough in these few days. Wonder whether severe cough would cause my ERM to progress to macular hole or even retinal detachement?

I do not want to have further complications to my eye conditions during this healing period for my flu and bronchitis.

Thanks for your advice

Thanks Dr Harshita for your reply.

Currently, I have enlarged and distorted images for my right eye. This imbalance of image sizes makes my vision strange and I feel very uneasy, sometimes with distance disparity. Is this imbalance called aniseikonia? I am currently quite upset by this problem. Will this problem be completely removed after erm surgery?

Thanks and regards,

Thanks Dr Harshita for your reply.

Currently, I have enlarged and distorted images for my right eye. This imbalance of image sizes makes my vision strange and I feel very uneasy, sometimes with distance disparity. Is this imbalance called aniseikonia? I am currently quite upset by this problem. Will this problem be completely removed after erm surgery?

Thanks and regards,

Dear Dr Harshita,

Thanks for your promp reply. The distortion (imbalance) I described is not present before ERM. Then I could expect substantial improvement after ERM surgery?

Will the problem of aniseikonia develop after the surgery? I asked because I learnt from a fellow patient that he has developed this after ERM surgery. I am worried.


I also have some questions regarding cataract development after ERM surgery. I know that Cataract will soon develop after vitrectomy. If cataract surgery i subsequently performed on my ERM eye (right eye), I will have great differences between LE and RE in terms of myopia. I do not want to replace my LE lens together with my RE lends as the lens of my LE still clear. But how to overcome the vision imbalance (LE is about -9.00 myopia) without replacing my LE lens?

Doctor said I could leave about -2.00 for my RE upon cataract surgery, and then wear contact lens for LE only. But my question is will I feel very uncomfortable or even dizzy with such great differences? Any suggestions and advice?

Thanks much for advice

Dear Dr Harshita,

Thanks for your promp reply. The distortion (imbalance) I described is not present before ERM. Then I could expect substantial improvement after ERM surgery?

Will the problem of aniseikonia develop after the surgery? I asked because I learnt from a fellow patient that he has developed this after ERM surgery. I am worried.


I also have some questions regarding cataract development after ERM surgery. I know that Cataract will soon develop after vitrectomy. If cataract surgery i subsequently performed on my ERM eye (right eye), I will have great differences between LE and RE in terms of myopia. I do not want to replace my LE lens together with my RE lends as the lens of my LE still clear. But how to overcome the vision imbalance (LE is about -9.00 myopia) without replacing my LE lens?

Doctor said I could leave about -2.00 for my RE upon cataract surgery, and then wear contact lens for LE only. But my question is will I feel very uncomfortable or even dizzy with such great differences? Any suggestions and advice?

Thanks much for advice

Thnaks Dr. You said I may wear contact lens for the other eye. But with great difference, (my LE - 9.00 myopia, RE corrected to -2.00) after cataract surgery, even if I wear contact lens for LE, will i feel dizzy or other discomfort ?

Thanks and regards,

Thnaks Dr. You said I may wear contact lens for the other eye. But with great difference, (my LE - 9.00 myopia, RE corrected to -2.00) after cataract surgery, even if I wear contact lens for LE, will i feel dizzy or other discomfort ?

Thanks and regards,

Thanks Dr Harshita,

Dr, I want to go to hair salon to perm my hair, which involves use of chemicals? If I do this before the surgery, is it OK or it will have impact on my disease?

What if I perm my hair after the surgery? When is the appropriate timing?

Thanks.

Thanks Dr Harshita,

Dr, I want to go to hair salon to perm my hair, which involves use of chemicals? If I do this before the surgery, is it OK or it will have impact on my disease?

What if I perm my hair after the surgery? When is the appropriate timing?

Thanks.