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Submacular Surgery

Accounts of Personal Experiences

(For a definition of this surgery and links to further information,
see the MD Support Glossary.)

Linda Olsen:

November 23, 1998 – The Surgery

I was too squeamish to ask what they would actually do to me, although I learned later the procedure wasn’t as ghastly as I’d been imagining. I was given a choice of local or general anaesthesia, and I opted for general. The surgery took place at 2:30 in the afternoon and by 5:00 I was back in the hospital room where I would spend the night. While it was not exactly a comfortable night, my biggest complaint was having to sleep on my stomach. When Dr. M visited me early on Tuesday to admire his handiwork, it took every bit of courage I could muster to open my eye. Dr. M waved his hand in front of me and asked how many fingers I could see. I saw a red blur. He seemed satisfied with my blur, patted me on the hand, and sent me home.

My parents came to stay with me for a few days, and I really needed their help. First, I had to remain face down for 48 hours. I was only allowed to roll over long enough to have eye drops administered or to have the patch changed. Besides, I had no idea how to administer the four different types of eye drops, four times a day!

On Wednesday, I finally got up enough nerve to look in the mirror and was surprised to find that it wasn’t horrible, just a little swollen and bloodshot. By Thursday, I finally mastered eye drops so I released Mom and Dad to return to their own lives. I still had frequent twinges of pain and headaches but Tylenol provided enough relief.

My gas bubble bounced and rolled around and compounded the vision difficulties, but it would only last a short time. It grew smaller by the day. One day it split into two, and then into many, and finally, after about 10 days, it disappeared altogether. Now I was looking through a rather coarse and dark veil of lace, but I could almost see through it.

The eye was a little weepy after the surgery, and the dressing needed to be changed frequently. I wore a patch for about a week, but when I developed an allergic reaction to the adhesive tape, Dr. M said I didn’t really need it anymore, and I was glad to be rid of it.

Dr. M had recommended that I take a month’s leave from work to recover from the surgery, and it was indeed a month before I was able to return to work on a full-time basis. I tried to work half days, but found that within a few hours, I’d develop a whopping headache, and a new symptom began to manifest itself – nasty flashing lights – if I became tired or stressed.

December 19th checkup – the eye is healing nicely, but still no big E.

January, 1999:

The post-operative discomfort was gone by Christmas, but the gray spot remains – less solid, with the lower half more like a gray smudge than a blotch. Using both eyes, I see life through a slight blur. Other symptoms are distortion of line, flashing lights, slight double vision (a result of each eye seeing something slightly different), and now I have an annoying little floater. But it’s healing, and all will soon be well.

I can drive with confidence. Reading is made easier using magnifiers bought at the neighborhood drugstore. The pair that work best for me don’t have much magnification, but the difference is profound. My company has kindly provided me with an extra large monitor. Even so, proofreading my work is not working very well – those typos used to practically pop off the page, now they literally disappear.

January 19th check up

A remarkable improvement! I finally saw the Big E! Not only that, the images of the other lines on the chart are almost penetrating the smudge, but I can’t quite read them yet. Dr. M tells me to keep my fingers crossed. And, although my left eye is still vulnerable to recurrence, he feels the likelihood of my losing the vision in my right eye is remote. He recommends that my diet include spinach, kale, egg yolks, zucchini, kiwi fruit, red grapes, apricots and carrots 2 to 3 times per week. I’m to take Lutein pills 2 times per week, and Ocuvites on alternating days.

Tom Jordan:

Submacular surgery may be an option for people with wet MD in the earlier stages. (First six months to a year.) It is used for both choroidal neovascularisation (CNV) and sub macular hemorrhage (SMH). It involves microscopic surgery to remove the neovascular membrane back of the macula. It is done with a local or general anesthetic. It is considered major surgery. It has some risks. We people with MD know however, that the greatest risk is in doing nothing.

The majority of people who have had this done consider it beneficial. Sometimes there is improvement. Sometimes there is a dramatic improvement. It is usually done to maintain the eyesight at its present level. It does seem to maintain the peripheral vision in many people very well. A complete vitrectomy is done with a gas bubble inserted to keep the retina in place. Your eye is aired up like a tire. Each day natural fluid will replace part of the gas bubble in the eye. A face down period after the surgery is required. The gas bubble must be kept positioned at the back of the eye to keep the retina in position. This face down procedure sounds worse than it really is. No problem there. I rather enjoyed the opportunity to just stop and do nothing. I had no discomfort or pain after the surgery.

I had this surgery seven years ago with satisfactory results to date. This eye is now 20/200 with excellent peripheral vision. The other eye which had no surgery is 20/400 with limited peripheral vision. I noticed an improvement in brightness of view and color immediately after the surgery. The peripheral gradually improved and the scar grew smaller. (The dark spot grew smaller.) As the scarred spot got smaller, it became easier to see around it. Hence, the improvement in close in peripheral vision.

I would recommend sub macular surgery to anyone fortunate enough to qualify for it. I think it saved some of my vision and saved my life. It certainly gave me hope for the future. I have not lost that.

Camille Guy:

I had submacular surgery to remove the scar tissue on my macula, following three pdt treatments over the past year. The surgery was suggested in the hope that my vision might be improved ie the cloudy grey patch in the centre of my vision would become smaller or less opaque.

The RS offered no false hopes for the submac procedure, suggesting I had about a 30% chance of improvement, and the same of the vision either worsening or remaining the same. More positively, he thought I was a suitable candidate (meaning, I think, that my neovascularisation was anterior to the RPE and there was only a small break in the Bruch’s membrane and a few other good signs). He did the operation under local anaesthetic, and it lasted 51 minutes.

I was lying on my back and sedated, so only woozily aware of what was going on (as a journalist I suppose I should have forgone the sedation..) What I do recall was occasionally seeing what looked like instruments in my eye (is that possible?) and towards the end I saw thread that was being used to stitch the eye and seemed to feel the stitching. Earlier I noticed a suction sound that was presumably the removal of the vitreous humour. I heard the theatre nurse saying “awesome”, which I think referred to the way the surgeon managed to remove the scar tissue intact. They gave me the tissue as a souvenir – it is like a small freckle. I heard later that the surgery had gone very well, only a tiny hole was made in the retina, and it was in exactly the right spot for removal of the scar tissue.

The bad news was that once the local wore off my eye felt as though it had a razor blade in it. I stayed in hospital overnight and had pethidine twice. Over two weeks the pain slowly diminished until it felt more like a misplaced contact lens in the eye. I gather this degree of pain is not usual and I recall that I was unable to tolerate contact lenses when I tried them for several months 30 years ago (my eyes could stand them for about three hours only). So don’t let my experience put anyone off – my eyes are probably just over sensitive!

I just wish I had known it would be like that (and I also wish the RS had been more willing to prescribe something stronger than Panadol – only Codeine seemed to relieve the pain for me and fortunately I had some). I was left with a large gas bubble in the eye and told to remain face down three hours daily, to sleep on my right side, and use dilating and antibiotic drops every few hours. The three hours was such great news as I had been expecting to stay face down all the time. At my one week checkup the RS said my retina was looking “wonderful”. I saw him again today and again he thought my retina was looking great. Not that I can tell yet whether there had been any vision improvement. Somehow I expected the gas bubble would only last two weeks, but I learned today it could be six weeks. Looking through the gas bubble is like seeing underwater without my prescription goggles (for myopia). It’s murky and blurry. I can see the fingers of my hand at six inches and I can see a grey blob like a generous sized ring on my finger. What I can’t yet tell is whether that blob is smaller or less opaque.

I’ll report back once the bubble has gone and I can see more easily. Right now I can read only by covering my bad eye and holding pages an inch or two from my good eye. Reading the screen is possible but more of a strain than usual.