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Vitrectomy for vitreous bleeds

Discussion in 'Diabetic Retinopathy' started by Jay78, Mar 29, 2016.

  1. Jay78

    Jay78 Type 1 · Newbie

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    Hey all.

    I have been type 1 for 32 years with poor control for a lot of that time.

    I was put on the Omnipod 4 years ago now, which dramatically improved my control resulting in massive improvements of my HbA1C.

    Shortly before this though, I was diagnosed with proliferative retinopathy and had extensive photocoagulation in both eyes, albeit with delays due to cancelled appointments but
    that's a separate issue!).

    The left eye has a bleed every so many months but tends to clear within 6 weeks. The bleed means that a white cloud obscures my vision and occasionally I get black tendrils and shooting dark spots.

    I am able to read down to the penultimate line on the sight test when my vision is clear or even partially cloudy but my new consultant thinks I am using the other eye which I can't be as it is covered during the test and I shut my other eye anyway. However at my last appointment I read down to the penultimate line with the nurse but then could only get to the 2nd line with the consultant as the cloud had come across in the time it took to be called in which is how I think they arrived at the conclusion of using the other eye!!

    I had a different surgeon who put me in for the vitrectomy in December 2014 but then cancelled and then forgot to rearrange until I started making complaints in June 2015. I had had trepidation at this point as when asked what he would advise a family member, the response was "well as a surgeon, you want to get all the experience you can".

    Following the cancellation and the non follow up, I decided I wanted a second opinion. At this point I had another minor bleed but the consultant was adamant that for the potential risks, my sight was still too good for them to advise a vitrectomy.

    However this surgeon has recently been promoted into a more management orientated role, and the new consultant (who thinks i am subconsciously or consciously cheating on the eye test!) has me booked in for surgery in 2 days time! Nothing is being done to allay my fears and i don't feel as though i can ask them any more questions as i sense a feeling of " not another indecisive patient"

    Despite the official success rate, there are a lot of posts describing worse bleeds than before, to blindness of the eye operated on and only a couple where patients have had no adverse experience and are glad they had the surgery.

    I know a cataract is inevitable, but as I say they have done extensive laser, there is no issue or likely to be an issue with the retina and the only negative is the fact that my vision is occasionally obscured.

    Any thoughts, advice? Should I delay until the vision is completely obscured for longer or am I being a big girls blouse and should ignore the horror stories because they represent a small proportion of unlucky people? Any one else had positive results?
     
  2. noblehead

    noblehead Type 1 · Guru
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    Odd thing to say as the other eye is covered during the sight test, but above else why would you want to cheat when it's your eyesight at risk?

    The bleeds look like a spiders legs, when you see the dark spots that is the bleed dispersing, if your having frequent bleeds then it could be that the vitreous gel is pulling on the new blood vessels resulting in the haemorrhages.........hence why they want to go ahead with the operation.

    Please don't be scared to speak up if you have any concerns, it's your eyes and if you have any doubts or concerns then you need to speak with the Ophthalmologist.

    The success rate is high as you've mentioned, I had a vitrectomy operation and have no regrets whatsoever, it's quite normal to develop a cataract in the operated eye post-surgery but don't let that worry you, the cataract op is painless and is over with in around 15-20mins.

    Without saying any more have a look at the following, it has some great information and advice on diabetic retinopathy and the link takes you straight to the Vitrectomy page:

    http://www.diabeticretinopathy.org.uk/vitreous_hemorrhage.html

    Good luck and hope all goes well.
     
  3. Dark Horse

    Dark Horse · Well-Known Member

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    All surgery has risks, and all surgery should have informed consent from the patient. Patients should understand the risks of surgery and, on the other hand, understand the risks of not having surgery. They should be able to weigh up the risks and make the best choice for them.

    Some of the risks of surgery are discussed here:- http://www.docshop.com/education/vision/eye-diseases/diabetic-retinopathy/vitrectomy As you can see although most people's eyesight improves with vitrectomy, a small percentage of people lose vision.

    If your bleeds are interfering greatly with your quality of life and / or the prediction is that you may develop worse complications, you may decide the risks of vitrectomy are worth taking. On the other hand, if you have only occasional bleeds which clear up quite quickly and the prediction is that they may eventually stop happening, you may decide that the operation is not worth the risk.

    Your surgeon should be able to talk you through both the risks of having surgery and the risks of not having the surgery. Don't be afraid to speak up and possibly postpone your surgery until you feel sure you want to have it. It is also worth asking how many vitrectomies the surgeon has performed.
     
  4. Jay78

    Jay78 Type 1 · Newbie

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    Hi noblehead and Dark Horse,

    Thanks to you both for responding and for the links.

    I am told that the reason the left eye keeps bleeding is because one of the new vessels has grown into the vitreous humour creating a bridge but this new vessel is weak in comparison and as such, each time the vitreous moves, it moves and stretches this weak bridge which breaks and then bleeds.

    Since the beginning of this year , I have had one what I call major and 2 minor bleeds and as of this moment I have a tendril which shoots all over the top part of my view as I move my eye but otherwise clear vision. That said it is easy to forget how annoying it is when it first bleeds, when your sight is restored.

    The hesitancy comes from firstly how the initial surgeon responded ie as a surgeon you always like to get the practice, secondly that on referral I was told that due to how good my sight still is when clear, they wouldn't consider a vitrectomy to then finally have a third surgeon tell me that they will put me in for a vitrectomy but if I am unsure then to delay which suggests that the operation is not urgent vis a vis it being vision saving!

    It's difficult to perceive what the surgeons goals are: do they just want the practice or is it in my best interest to have the surgery? I asked my recent surgeon how many vitrectomies they had performed and the response was that they stopped counting once they reached a thousand which was hard to stomach as they are very young and as I subsequently checked, have only been licensed since 2009! They never give a straight answer and this coupled with the stories I then come across have left me not knowing what is in my best interest!

    I have also had poor experience in the last 5 years with surgery and this also adds to my trepidation.

    That said I have been looking at something called micromort and to be honest I'm now at the stage I think that if it is going to go wrong, it goes wrong. If there is the chance that it long term eradicates the bleeds but worsens my visual acuity, I get a new prescription. If my field of vision is affected to the extent that I can't drive, my rationalisation is that I haven't driven since September of last year and at the end of the day in 5 years or so we'll all be in cars that are driven by a computer program anyways! If the worse happens and I do lose sight in my left eye permanently, well millions of people lose their sight and worse and still manage to function as human beings.

    Thanks again though and I shall keep you informed :)
     
  5. noblehead

    noblehead Type 1 · Guru
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    Thought it would be something along those lines @Jay78

    Again it's your call but I really do understand your fears and concerns having been there myself, it's not nice having surgery and its human nature to fear the worst, best wishes anyway and hope it all works out well, do keep the thread updated and let us know how you get on.
     
  6. Dark Horse

    Dark Horse · Well-Known Member

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    Well, you sound like you have a very good perspective on it all and will make as good a choice as anyone can. Good luck and, yes, please keep us informed of how you get on.
     
  7. the_anticarb

    the_anticarb · Well-Known Member

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    I didn't hesitate to have a vitrectomy when I had a bleed. Risk of tear is about 1 in 25. My vitrectomy was largely successful. I had tiny hole resulting in a small patch of field loss in my left eye but with both eyes open the right eye compensates.

    For me, it was that or risk a retinal detachment as the vessels were growing into the jelly so there was no choice really.
     
  8. hvicten_

    hvicten_ Type 1 · Newbie

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    Hi Jay78,

    I developed proliferative retinopathy during pregnancy, after living with diabetes for 20 years. I was limited to treatment due to my situation, so stuck to vigorous laser every two weeks for 5 months, during delivery I suffered a big hemorrhage in my left eye which left me with partial vision, I then was referred for my first vitrectomy.
    Needless to say, for me this was a life changing/eye saving procedure which without I dread to think where I would be. I was lucky enough to have my treatment in Moorfields, and I couldn't be more thankful for the care I received! I then went on to have a vitrectomy in my right eye six months later.
    Don't be afraid, all surgery comes with a risk, however I have great faith in all the consultants performing eye surgery. I'm now 28 and have almost perfect vision!
    If it's recommended to you, don't resist. Large hemorrhages can lead to retinal detachment which could then leave you with no options.

    Good luck
     
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