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EYE SURGERY
CATARACTS - EPIRETINAL MEMBRANE

Personal experience by Miloš Kaláb
with a link to
Tom Raymond

Important information about many eye disorders
may be found in this Health Dictionary.

Visitors since January 1, 2001:
Updated December 6, 2014.


Historic Introduction

      The description of my personal experience with several kinds of eye surgery has been at this site since 2001. Now, 13 years later, in 2014, the description which follows, may only be of historical value. Surgical procedures are now all different from the ones which I experienced only several years ago. A good example is the removal of the epiretinal membrane. Even now, at the age of 82 years, I still do electron microscopy and, thus, work with younger colleagues. One of them had his epiretinal membrane removed earlier in 2010 - and he was back at work a week later. He did not receive the heavy SF6 gas in his eye and he did not have to lie for a minimum of two weeks with his face down so a new vitreous could develop in his eye. His eye was filled with a common physiological saline. On the other hand, his surgeon did not explain to him what he will do and how he will do it. When we met in the laboratory after his short recovery, he said to me that there was no chance that he could talk to his surgeon as I did with mine. Also he said that he saw no interstiong features during surgery whereas I was able to follow (and understand) most procedures taking place in my eye. After this discussion, I searched for and found my eye surgeon and thanked him again for the way he had treated me ten years ago.
      Many readers have written to me to and asked a variety of questions related to their state. I appreciated their letters and I replied each of them. I hope that my replies alleviated their concerns and that the surgeries helped to restore their ailing sight. Everybody scheduled for eye surgery wishes that any sight deterioration is stopped - and reversed. The alternative - the loss of sight - would be horrible. What I can do today for the readers of this old story, is to advise them to take care of their sight. There is ample information, e.g. at All about Vision.

The objective of this website is to show what happened to me. Some people may have developed similar eye problems as those which had afflicted me - cataracts in both eyes and then a repeated formation of an epiretinal membrane in my left eye.
      I can imagine the feelings of despair if a patient gradually loses his/her vision and fears the loss of sight, because my grandfather died blind and my mother started to lose her vision a few years before a similar problem afflicted me. For many years, even before developing my own problems, I have been contributing to Operation Eyesight Universal, a charitable organization which helps to restore the sight to people in underdeveloped countries. The Canadian National Institute for the Blind is another charitable organization; it assists Canadians.
      Now I myself had undergone 3 eye operations, all very successful. Certainly, each individual's situation is unique. However, the following text and images should encourage everyone, who is scheduled to have his/her sight improved or restored, to face the operation with confidence in the surgeon's skills and with faith in success.
      I used to work as a microscopist and because of unusual light reflections in one of my microscopes, I had been able to follow what had been happening in my eyes. That may appear scary but advances in ophthalmology have changed the fearful situations into a unique and encouraging experience.
      Thanks to eye surgeons, I still read (born in 1929) without glasses, I still do microscopy, and I see well even at a distance whereas otherwise I would have been blind.
      Since I am now over 80 years old and drive a car in the province of Ontario, I must pass a vision test and the test of driving knowledge every second year. Vision requirements are specified here:
      • A visual acuity as measured by Snellen Rating that is not poorer than 20/50, with both eyes open and examined together with or without the aid of corrective lenses; and
      • A horizontal visual field of at least 120 continuous degrees along the horizontal meridian and at least 15 continuous degrees above and below fixation, with both eyes open and examined together.


My grandfather died as a blind man soon after the end of World War 2. I remember his last years when he used to visit an ophthalmological university department in my hometown in Czechoslovakia. The good professor of ophthalmology promised that a treatment will be started when the cataract "fully matures". Grandpa understood that he himself will "mature" before the cataract will, so there will be no need for any treatment. He was right as there was no treatment for this dreaded affliction at that time.

My mother started to lose her sight when she became an octogenarian. At that time in the nineties of the past century, there was already a treatment - lens replacement. My mother did not believe in it and refused any suggestion that her sight could be restored. "Who has ever heard about operating an eye? And in an old person? When would the wound heal - if ever?" She died at the beginning of 2005 and until that time she was able to read my printed letters thanks to having her diseased lenses replaced with artificial ones several years ago. She would have celebrated her 98th birthday in the summer of that year.

And myself? In the nineties, although I was still relatively young (slightly over 60), I noticed that every window had very soft outlines when viewed from a room. The light from outside was shining over the window edges. It was clear to me that I have inherited a susceptibility to cataract development from my mother. Unlike my grandpa, however, I knew that there was a cure.

As a microscopist, now living in Canada, I was able to follow the development of a cataract in my left eye. It was scary to see twice a month how a yellowish blob was spreading from the left upper corner of the eye, eventually reaching the centre (Fig. 1). (The image could not be photographed - it was drawn from what I saw in my microscope). An optometrist confirmed that a cataract was developing and referred me to an ophthalmologist, who suggested surgery. It is a little weird to admit that the mother of a man close to retirement warned him not to have surgery lest he was willing to lose his sight completely. That was my case.

Fig. 1.   Development of a cataract as a patient may see it because of reflections when looking into a microscope
Fig. 2.   My lens (white object) is being broken down and the eye is washed with a solution (swirls)

The 30-minute surgery, done under local anaesthesia, was interesting to follow. I saw how the lens was disintegrating. It appeared as a white block tumbling in the eye and gradually decreasing in size on a blue background. Occasionally there were swirls seen (Fig. 2) as the eye was washed with a solution by the surgeon or her assistant. At that time (1993), the opening in the eye was about 6 mm long and was closed with stitches after the insertion of a plastic lens. At that time, a plastic lid was used to protect the eye from accidental contact with a hard object and a few painkiller pills were needed early after surgery. Perception of light and colour returned very soon but there was a feeling that blue hues were more prominent. Reading was restored 6 weeks later after the stitches had been removed. I greatly appreciated the fact that the new lens allowed me to read without glasses.

Being an example for my Mom. Of course, I wrote my Mom about the success of my operation. She became excited and wanted to have both her eyes operated as soon as possible. In Canada, the operation was done in half an hour and then I was released to go home. Mom, however, stayed in a Czech hospital after surgery for two weeks. At her age it suited her better than to be released immediately and then to take care of herself. She was very happy with the result and described it as a return from the world of darkness back into the world of light and colours. Interestingly, without my affliction and decision to undergo surgery, she would be blind as her father had been.

Fig. 3.   A laser beam is used to cut the membrane on the new plastic lens a year after its insertion.
Fig. 4.   The membrane retracts as the cut widens forming a window to view the world clearly again.

A year after my first surgery, a membrane started to cover the new lens in an attempt of the body to reject it. Laser surgery made a line of tiny holes in the membrane until it ruptured. Fig. 3 at left shows the colour flashes seen during surgery but not the formation of the holes in the membrane. I observed it in the microscope only after my return from the ophthalmologist. The ruptured membrane retracted towards the perimeter of the lens and the hole formed again opened for me an unobstructed view of the world. I am able to see the hole in the membrane by looking into one of my microscopes. It took several years until the hole was enlarged to the present state indicated by the last image in the animated series in Fig. 4 at right.

A few years later, my right eye had a similar problem. In 1997, however, there was an option to pay $200 and obtain a different kind of lens by a more sophisticated surgical procedure. Later this surcharge was abolished. This second operation lasted for only 15 min., the wound was only 3 mm long, and there was no need for stitches. I was able to read and drive the car on the next day after check-up by the surgeon. The operation was done so quickly that very little except the overhead lights was seen during that time.

Two years later in the fall, I was turning sod in the garden. A severe pain suddenly struck my left eye and the flow of tears could not be controlled. I had to discontinue my work. A few days later, an ophthalmologist checked my sore eye. She asked me whether I suffered from diabetes or high blood pressure. No diabetes - but I used to take pills against high blood pressure. The doctor referred me to the Eye Institute of the Ottawa Hospital with a suggestion to have my retina checked.

A membrane on my retina? The first examination at the Eye Institute revealed, in addition to my eye disorder, high blood pressure (although I use to take two kinds of medication). Fortunately, my family doctor found a more efficient combination of medicines - but it took some time. After my blood pressure had been stabilized within normal limits, I had another examination at the Eye Institute. As part of the examination, an angiogram (Fig. 5) was obtained by injecting a fluorescent dye in a vein in the back of my hand and by photographing the retina as the dye entered the tiny veins in it. Consequently, the surgeon concluded that I suffered from epiretinal membrane rather than the more severe macular degeneration that I was concerned about. Whatever I looked at did not appear as sharp in the centre of the eye as a few months ago. The epiretinal membrane somewhat obstructed my view.

Fig. 5.   An angiogram of the afflicted retina shows the distribution of fluorescein in the veins 32.2 s after injection.
Fig. 6.   An angiogram of the afflicted retina a year later shows deterioration in the central region. (This image was obtained 35.3 seconds after the administration of fluorescein).

Radical treatment suggested The surgeon suggested surgery as the only effective treatment of my disorder. This time, unlike with the cataract surgeries, I was very cautious. It would be a "scalpel" surgery - opening the eye through the sclera, draining the vitreous, replacing it with gas, lifting the membrane away from the retina and removing it using a sophisticated pair of tweezers. Were there any risks involved in this procedure? Yes, anything we do involves risk. In this case, infection, detachment of the retina, even a rupture of the retina could be encountered although the probabilities were very low. The doctor was frank. So far, no infection has ever afflicted any of his patients. The other risks were small but real. I decided to wait - but that was no solution since the membrane was expected to grow, thicken, and eventually affect the underlying retina. If delayed for too long, surgery would not restore my original sight.

It took me another year before I called the Eye Institute if surgery was still possible - and was offered it promptly after another angiogram (Fig. 6) confirmed deterioration of my sight.

Surgery Following pre-surgery tests, I entered the Eye Institute on October 10, 2000 at 10 a.m. I knew that there would be no overnight stay in the hospital and that my wife would pick me up with her car after surgery. Interestingly, other patients had their relatives or friends waiting for them in the hospital. Not being accompanied by my wife in the waiting room, I was asked, if I was a lonely man. Well, my wife and I just viewed this situation differently from others.

Dressed in a hospital gown and lying on a bed with wheels, I was briught into the operating room just before the noon. There, the atmosphere was very friendly. I greeted all four members of the surgical team, i.e., the surgeon, the anesthesiologist, and two surgical assistants. Then I moved my body from the bed onto the operating table and the operation could have started.

Fig. 7.   The instruments subsequently seen inside the eye during surgery: vacuum pipe (bottom left), gas pipe to lift the membrane (middle), a pair of tweezers to remove the membrane (top). Tiny blue beads of an antibiotic were the last to enter the eye; tiny black dots separated from them and moved "up".

First, however, an intravenous needle was inserted into the back of my left hand (later I was shown that it was made of plastic and could be bent) but I remained fully conscious and tried to remember the outlay of the overhead lights.

Soon I saw blue and yellow colours dancing in my left eye and a small rod entering the interior of the eye. Evidently, draining of the vitreous had started and I asked if also a large float would be removed. With a relief I saw it soon disappear. Then sharply bent rod appeared in the eye. Perhaps to lift the membrane with gas? Only then I saw that the membrane was indeed there, covering a relatively small part of the centre of the field of vision. It had a reticulated structure. (The gas that was used to fill the eye was sulfur hexafluoride, SF6). And then a sophisticated pair of tweezers entered the scene (Fig. 7), capturing the membrane and pulling it out. If I remember correctly, this procedure was repeated twice or three times. After that the tools were no more visible but from another site in the eye, some 20 to 40 tiny blue beads in a stream entered the eye. Minute black dots seemed to separate from the beads and to move in a different direction. "What were they?" I asked the surgeon and he explained that this was an antibiotic. In fact, I asked various questions during the operation (and received explanation). I overheard the staff mentioning that I was quite an exceptional patient interested in all steps of the operation. After the eye had been closed with stitches and protected with a plastic lid taped in place, I moved my body back on the hospital bed, thanked the surgical team, and was hauled out of the operating room to the recovery room. There I was disconnected from the intravenous bottle. My blood pressure was somewhat elevated (160/90) but soon my belongings were brought to my bed. I dressed, now keeping my head facing down, and after sitting in a chair (my option) for a few minutes, I was told that my wife had arrived (after being called by the hospital clerk). I was hauled in a wheelchair to her car parked in front of the Institute entrance. At 2:45 p.m., one hour after surgery, I was at home in my bed following the advise to lie and even to sleep with my head facing down for a minimum of 90% of the day until the gas was replaced with my own vitreous.

Fig. 8.   Two days after surgery, the eye was swollen

On the next day before check-up, an eye technologist removed the lid from my eye and I was advised to use it for protection only at night. To my amazement, the technologist asked me to read the letters on the typical eye examination light box. All I saw was a milky fog. Or was it? It was even more amazing that I saw the largest letter E. Then the surgeon examined my eye and was satisfied with what he saw although to me and my wife the eye looked awful (Fig. 8).

With the head facing down - most of the time, I was comfortably able to eat. Straws were used to drink juice, tea, and even milk. There were no problems in the bathroom either. In fact, the toilet bowl was a measure of the progress how the gas was replaced with the vitreous. Immediately after surgery, the entire bowl was obscured with the milky disk in the operated eye (when the good eye was closed). Gradually the bowl became better visible through the translucent disk...

No pain in the eye or anywhere else. The next check-up was scheduled a week later. It is very pleasant to note that I had absolutely no pain in the eye either during or after surgery and that I did not need any painkiller whatsoever. A band around the milky centre in the eye started to expand and I was able to see things in the bedroom and bathroom. The milky part turned very soon after surgery into a translucent disk which made me feel as if looking through water. The border with the transparent band indicated that it was the level line and that the centre was probably liquid. The dimensions of the very mobile liquid centre, through which at least large subjects could be seen, decreased each day a little until about 12 days after surgery, there was only a small bubble remaining. Occasionally, with the movement of my head, one or two very small bubbles separated from it and soon merged with it again. It is interesting to note that initially it was the liquid in the eye that was perceived and latter a bubble became prominent as the eye was almost fully filled with the liquid. Two weeks after the surgery, there was no bubble in the eye whatsoever, so the following day I drove to work, where I spent a part of the day reading e-mail messages. A look into one of the microscopes revealed a crystal clear vitreous. What a difference from my 71 years old vitreous in the right eye! If I were younger with a prospect for a long career in microscopy, I would certainly ask to have the "good eye" drained to replenish it with a fresh clear vitreous. The doctor found my idea somewhat unusual.

A gradual return of three-dimensional vision when using a dissecting microscope has improved my ability to mount specimens for scanning electron microscopy as well as my ability to focus images obtained by transmission electron microscopy. Another examination two months after surgery showed an improvement in my sight and a new angiogram confirmed the success of the operation.

In the spring and in the summer my sight was gradually improving although it did not regain the ability to read regular newspaper text. However, larger text could be read as well as the license plates of cars before me - without glasses. Then my sight started to deteriorate. Had I been informed about the existence of the Amsler Grid, I could have checked what was getting wrong. It was a friend of mine who told me about it. The grid may be found at several Web sites. The grid may easily be printed from the Website or the text may consist of large letters to read more easily for people with eye problems. Yannuzzi modification of the grid is smaller with black background and white lines (page 811). Both grids are useful to detect early defects in the retina. In my case, the distortion of the grid was substantial but I do not know what it could have shown me a year ago.

How I saw the Yannuzzi Grid in February 2002. In 2008, the distortions are considerably smaller and there is only a small "blind spot one square diagonally to the right and up from the centre.

When I looked at the Yannuzzi card with my operated eye in March 2002, I saw the white dot in the centre but the grid appeared distorted, higher at the right margin than at the left. In addition, I saw a dark gray cloud as shown in the diagram at left. By focussing elsewhere on the grid, the cloud moved along. This indicated to me that the retina has been warped and distorted off centre. Lately, this gray spot may also be seen if I use only the operated eye and look at some prominent points of interest like a small airplane in the sky - by looking at it slightly below and to the left. Then the small object "disappears". Fortunately, this bad vision is only around the centre of vision whereas I see things, though not focussed, farther out in all directions. My right eye has good vision and I am still able to read newspapers without glasses. I have been doing electron microscopy with no problem but this is because large SEM images are observed on a computer monitor. TEM work is somewhat more difficult, particularly because it involves an ultramicrotome where a diamond knife is manipulated to cut thin sections. Some 20 sections are then captured on a "grid" - a dense mesh 3 mm in diameter. The work is done using a microscope. My deteriorated vision in the left eye then tires my sight. The vitreous in the "good eye" has been developing translucent filaments which move like light curtains in a breeze when I look down a particular light microscope.

I protect my eyes from the sun by dark glasses. It seems to me that I have a genetic predisposition to cataracts. Could I have harmed my eyes in some way? I used to do copper enamelling every fall for about 20 years (evenings until midnight) working red-hot copper pieces in a kiln with the door slightly opened. Every summer, I would be windsurfing and sometimes the sunglasses were not sufficient to reasonably reduce the sun's glare on the water. A few weeks before the epiretinal membrane developed in my left eye, I was turning the soil in the garden and experienced a sudden pain the left eye with tears flowing down my face. The pain forced me to quit my work. I completed it gradually in the subsequent days but I visited my ophthalmologist only a few weeks later and it took a few months before I was examined by a retina specialist. Would it have been better without the delays?

On April 9, 2002, I had another check-up. Two specialists examined me thoroughly, also using multifocal electroretinography (ERG). The surgeon confirmed that my suspicion was correct - there was a new epiretinal membrane in my eye. Apparently it grows back in only about 5% of patients and I was one of them. Then the surgeon offered me surgery in a few days. This time, there was absolutely no hemorrhaging around the eye, just a little swelling and a week later, nobody who would look in my face would believe that I underwent eye surgery a few days ago.

In December 2014 (half a year after my 85th birthday) I am still mounting specimens under a dissecting microscope and doing electron microscopy of microorganisms as an Honorary Research Associate. Although I can still read newspapers and view computer monitors without glasses, I feel mor comfortable with reading glasses. Of course, I use glasses for driving. The operated eye has gradually improved although it is not as good as the right eye. Its vitreous, however, is crystal clear as I can see in my Olympus BH-2 optical microscope whereas translucent strings have developed in the other eye which has been my dominant eye. When I asked the ophthalmologist and the eye surgeon whether I should consider plain vitreotomy sometime in the future to replace the stringy vitreous with a clear one, they both responded with a strict "no" because they viewed my question as mischievous, although I was serious. I was told that I have been lucky so far and that I should be satisfied with the state of my eyes.

The pressure inside my eyes (intraocular pressure - IOP) started to increase with time, although I have been using eye drops (Cosopt and Brimonidine, twice a day in each eye). High IOP would damage the optical nerve and lead to glaucoma. Thus, in September 2008, I had eye surgery called argon laser trabeculoplasty to improve the drainage system in the eyes. Opening the fluid channels using a laser beam was followed by the application of corticosteroid drops (1% prednisolone acetate ophthalmic suspension) 4 times a day for 4 days. Eye surgery has again helped me to retain my good sight.

In 2013, my intraocular pressure increased to 18 mm Hg, which is too close to the upper limit and my ophthalmologist added Latanoprost drops to apply to my eyes in the evening in addition to Cosopt and Alphagal (Brimonidine). The pressure has consequently normalized.

Do I do anything special for my eyes? For many years, in addition to a regular diet, I have been eating raw vegetables and taking vitamin pills with lutein every day.


Acknowledgment I thank my wife Drahomíra for care before and particularly after surgery when I had to sit or lie with my face down all day and night for 2 weeks and for having to cope with manual work which I used to do but was advised by the surgeon to avoid for at least a month after each surgery.

Disclaimer: The author is not a health care specialist of any kind. He has described exclusively his own experience as he perceived it as a patient, a microscopist, and a scientist. His situation may differ from similar situations facing other patients. He advises anyone with eye problems to contact an ophthalmologist. The sole reason for this story is his desire to encourage eye disease sufferers to face their problems with confidence in their doctor and faith in their own healing potential.

Eye surgery procedures are completely different in 2011 from what they were 10 years ago. If you are scheduled to have your epiretinal membrane removed, look at it as an opportunity to have your sight restored. Do not postpone surgery, do not procrastinate. The situation may deteriorate with time: An epiretinal membrane or macular pucker is caused by a cellophane-like membrane that grows over the macular surface. In some individuals, this membrane contracts, which results in wrinkling of the retina. The contraction may mechanically irritate the retina and cause retinal swelling.

As the author I wish all the best to you.

©SCIMAT 2014