Macular Hole
Macular hole occurs in approximately 1 in 2000 people, more common in women aged 60-70y, it results in blurred, distorted central vision. Some patients notice a dull patch in the centre of vision. As time goes by the vision tends to become more blurred, but the peripheral vision is preserved.
Sometimes patients don’t notice the symptoms for quite a while, especially if they have good vision in the other eye.
Symptoms can resemble macular degeneration, which can require urgent treatment, so it is important that should you develop these symptoms, you contact your optician or eye care provider for an urgent assessment.
If caught relatively early, surgery can offer a good outcome for patients with macular hole. The amount of visual recovery does tend to depend on how much vision has been lost and the duration of symptoms.
Even with prompt surgery, because the condition affects the most delicate part of the retina, the macula, full recovery of vision is rarely possible, and some blurring / distortion of vision often remains. However around three quarters of patients do have a significant improvement in quality of vision, and find that vision with both eyes working together (binocular vision) is improved. The surgery can also prevent the condition getting worse.
What does the surgery involve?
The surgery is usually performed via a procedure called a vitrectomy [HL] and is often under local anaesthetic as a daycase. The vitreous gel at the back of the eye is removed using tiny instruments and a very fine membrane over the macula is removed before the eye is filled with a medical gas bubble. Typically taking around 45 minutes – 1 hour, it is often combined with cataract surgery and lens implantation at the same time as this can help the outcome of the surgery, and the macular hole repair procedure itself can accelerate the development of cataract in the eye.
Aftercare
Once the surgery is completed, the gas bubble gradually dissipates by itself and the vision, which will be very blurred with the gas bubble, gradually clears. This can take 3-4 weeks in some cases.
Often, there will be some specific face down positioning after the surgery for approximately 5 days, during the day, and your surgeon will explain this in more detail.
With modern vitrectomy surgery, the eye generally heals fairly rapidly with minimal discomfort. Occasionally there is some mild irritation, especially if sutures are used, but your surgeon will inform you if this is the case.
You will be prescribed eye drops post-surgery, and it is important you follow the relevant directions.
It is important that you avoid getting water directly into the eye for the first week after surgery, and swimming needs to be avoided for 3 months.
With gas inside the eye, it also means that you cannot fly in an aircraft, dive, or ascend to very high altitude, due to the effect of atmospheric pressure on the size of the gas bubble. Dangerous, sight-threatening rises in eye pressure can occur in these situations.
Normally patients are reviewed approximately at 2 weeks and then 2 months after the procedure to ensure everything is settling well.
If there are any unexpected symptoms, in particular increasing pain or dramatic drop in vision, or you have any other postoperative concerns, it is very important that you contact your surgeon. Emergency contact details will be provided upon discharge from the hospital.
