Macular Hole in Retina; Diagnosis and Treatment
Surgery and Recovery After Hole in Macula, Vitrectomy
Nov 8, 2009
A macular hole is a break in the macula. Macular holes cause blurry vision, distortion or a gray spot in the center of vision. A small partial thickness hole (one that doesn't extend down through all the layers of the retina) will be watched closely but may not require surgery. Once a hole reaches Stage III, or full thickness, it will need macular surgery. Some surgeons perform macular surgery for Stage II holes as well.
Why Macular Holes Occur
As people age, the vitreous, which is a jelly-like substance that give the eyeball its shape, shrinks and pulls away from the retina. This is called posterior vitreous detachment, or PVD. PVD can cause little strands of debris to float loose; people see these as floaters. If the vitreous is still tightly attached to the retina, as it pulls away, it may pull off a piece of the retina, causing a retinal hole.
Certain people are more prone to developing macular holes, such as:
- people who are extremely nearsighted (high myopia)
- people who have a retina detachment
- people who have a macular pucker
- diabetics
- people with eye injuries
Diagnosing Macular Holes: Fluorescein Angiography, Optical Coherance Tomography (OCT)
A retinal specialist can diagnose macular holes by examination with an ophthalmascope. Macular holes are usually confirmed with fluorescein angiography , a test where dye is injected into a vein and then tracked by a series of photographs as it travels through the veins and arteries of the eye, or ocular coherence tomography (OCT), which examines the layers of the retina.
Vitrectomy Surgery to Repair a Hole in the Macula
Surgery for a macular hole is done as outpatient surgery and takes less than an hour. Light sedation and local anesthesia is given; the eye is numbed with injections and eye drops. The surgical procedure is known as a vitrectomy. The vitreous gel is removed and replaced with a gas bubble that holds the retina in place. Vitreous fluid will replace the vitreous gel in time.
Patients will see the retinal specialist usually the day after surgery and several times thereafter before being discharged from their care. Several different eye drops will be taken a few times a day, to prevent infection and decrease swelling and pain. The eye will be very dilated for a week or two.
Staying Face Down After Macular Surgery: Vitrectomy Chairs
After surgery, patients need to stay face down for one to two weeks all the time, without exception, to keep the gas bubble in place. It’s much easier to maintain this position if the patient rents a special chair, called a vitrectomy chair, which allows them to watch TV with the help of a mirror, and read, play games and cards using the ledge below the headrest.
There may some pain and mild redness and swelling around the eye after surgery, but most patients complain more about the head down position than any other aspect of vitrectomy for macular hole surgery.
Vision Improvement After Vitrectomy
Most people have improvement of three lines of vision within six months after macular hole repair. Vision improves gradually over a few months. However, there can be complications after vitrectomy, such as:
- About 2-10 % of the time, a hole will reopen and surgery may need to be performed again.
- About 3% of patients will develop macular detachment and need further surgery.
- Greater than 75% all patients will develop cataracts in the eye that had surgery that will need to be removed within a year after the surgery.
People who have had a macular hole repair can’t fly in an airplane for up to three months after the surgery, due to the potential change in cabin pressure when flying.
After Vitrectomy for a Macular Hole
Most people have good results from macular hole repair, regaining a good amount of vision and not having any complications beyond cataract development that will need surgery within a short time. Remaining face down for the initial one to two weeks after surgery is crucial to achieving good results; renting a vitrectomy chair makes the time pass more easily.
Source:
Review of Ophthalmology, "Revisiting Macular Holes Advances in technology and refined surgical technique have led to better outcomes for patients with macular holes." Jon Wender, MD, J. Michael Jumper, MD; Vol. No: 14:02Issue: 2/1/2007
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