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I was diagnosed with an epiretinal membrane with pseudohole (macular pucker) in my right eye. Is this likely to be causing worsening diplopia? In the past I had cataract surgery in both eyes, and the right lens is now forming a secondary cataract. Which is likely to be the major cause of the diplopia?
A macular pseudohole is a depression in the central, high acuity portion of the retina lined by a condensation of the overlying vitreous which is termed an epiretinal membrane. You did not mention whether your diplopia (doubling of vision) is in that eye only or between your two eyes. Pseudoholes can distort the vision and lower acuity and sometimes split the image so that doubling is observed with the one eye only. If your doubling is between the two eyes, than the problem lies elsewhere—perhaps due to an eye muscle imbalance problem.
"Secondary cataract," also termed capsular fibrosis, is a common occurrence after cataract surgery in which the outer membrane of the natural lens (the capsular bag), which also houses the new artificial lens, thinks it is a lens and starts to make a thin layer of new lens material usually behind the artificial lens. Depending upon the pattern of new material, some slight image doubling can result. However, this is simply taken care of by a less than one minute laser procedure which opens a hole in the capsule bag eliminating the change and restoring the best possible vision.
Depending upon the diplopia you are experiencing, any of these can be a contributing factor and your treating ophthalmologist can sort them out for you.
Answered by: Richard Bensinger, MD
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