Dr. M. Anjali Shelbi
Ophthalmology (Eye Care)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My husband had segmental scleral buckle surgery three months ago. He also had two rounds of laser treatment afterward. He still has fluid behind his macula. Every evening he loses vision in the top part of his eye. Is this normal? He also informed my husband not to participate in any vigorous activities. However, my husband recently had his hair shaved and is now worried that his retina will become detached again. Could this cause his retina to detach again?
Hello,
Welcome to icliniq.com.
Since there is still some fluid behind the macula, it might settle down due to the effect of gravity by the end of the day, which can lead to vision loss in the top part of the eye. Do not worry, as the body will slowly absorb it with time. Since the macula was detached before surgery, good vision following the sclera buckle is still possible but less likely.
Treatment plan
Preventive measures
Regarding follow up
Patient's Query
Thank you doctor for the reply,
I have attached a picture of his fundus. Is there anything you see that is out of the ordinary? Has the laser surgery been done correctly? We worry that more fluid might enter his eye's bottom (at the edge of the retina). Could you give us your opinion of his photo?
Hello,
Welcome back to icliniq.com.
The fundus photo (attachments removed to protect the patient's identity) shows good laser spots and a buckle effect, but residual fluid is seen at the macula. You need not worry at present as it will be absorbed gradually. The retina seems to be re-attached.
Treatment plan
Patient's Query
Thank you doctor for the reply,
I am happy after consulting you.
Hello,
Welcome back to icliniq.com.
They have done B-scan (brightness), which detects retinal detachment. This test will not cause retinal detachment. So you need not worry about that. The doubtful lesion on the fundus picture (attachments removed to protect the patient's identity) seems to be laser marks. It is not a retinal tear with fluid. B-scan is showing buckling effect only with attached retina.
Patient's Query
Thank you doctor for the reply,
Could you explain your diagnosis in more detail? How does fluid behind the macula affect the top part of your vision in the evening?
Hello,
Welcome back to icliniq.com.
Your last OCT (optical coherence tomography) report (attachments removed to protect the patient's identity) shows only a little fluid at the macula. This cannot settle down due to gravity by the end of the day. Settling of fluid can occur in exudative types. The inferior half of our eye sees the superior half. Since he had pathology in the inferior half of the retina, he has difficulty in the superior visual field.
Patient's Query
Thank you doctor for the reply,
However, within the last few days, his vision seems to worsen. His feeling is similar to what he felt after the surgery. Everything appears much smaller in his left eye. He also feels fluid following his eyelid as he opens his eye. He says this is how he felt right after his surgery for the first month or so. Is this feeling normal?
Hello,
Welcome back to icliniq.com.
Regarding the symptom of seeing small, it is due to the little fluid at the macula, which raises and distends the basal attachment of the cones (photoreceptors) and separates them so that fewer perceptive elements are stimulated. Therefore objects are seen as smaller than they are.
Patient's Query
Thank you doctor for the reply,
For the last three days, my husband said he has returned to feeling what he felt just after his surgery. It has left us a bit scared because it came on suddenly. He sees a faint curved line that mirrors the line we have seen in his fundus images. The ‘seeing things smaller’ problem has also come on quickly. This also always happens in the evening. During the day, he seems fine. Are you able to explain any of these feelings?
Hello,
Welcome back to icliniq.com.
Did the symptoms start after you visited the doctor recently? Of course, if the latest scan has been taken, then it is not a matter of concern, as reassured by your retina specialist.
Patient's Query
Thank you doctor for the reply,
The symptoms have occurred within the last four days. The biggest problem is that he sees things as smaller. It is worse than it was after the surgery. The other symptoms I described in my last message tend to come and go. If the fluid behind his macula was getting smaller, why are the symptoms worsening?
Hello,
Welcome back to icliniq.com.
Micropsia may be caused by the stretching or compression of the retina, which changes the perceived image size because of the alteration in spacing between the photoreceptors. It can be due to retinal diseases such as epiretinal membrane (ERM), reattached retina, and macular edema. Also, retinal folds can occur due to compression of the eye by scleral buckling. A major cause of micropsia was persistent or transient macular edema and sub-retinal fluid. So, do not worry about seeing things small. There have been cases reported with similar symptoms after the surgery.
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Ophthalmology (Eye Care)
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