Macular Hole Surgery
One of the eye surgery options that we perform at Tygervalley Eye Laser Clinic is macular hole surgery. The eye contains a jelly-like substance called the vitreous. With age, the vitreous shrinks and pulls away from the surface of the retina. In most cases, this pulling away or vitreous separation occurs without any negative effect. A patient may notice floaters but no significant visual damage occurs. In some individuals however, there may be an area where the vitreous is firmly attached to the surface of the retina. As the shrinkage and forward movement of the vitreous progresses, pulling can be exerted on the retina, and eventually a small hole may form in the central portion of the retina (the macula), known as a macular hole. The fluid which has replaced the vitreous jelly in many areas may then seep through the hole, causing a localised separation of the retina centrally. This process results in a defect or dark spot in the central vision with distortion and central vision loss resulting.
Symptoms:
The severity of the symptoms is dependent on whether the hole is partial or full-thickness. The most common signs include eye problems such as:
- Blurred central vision
- Distorted, "wavy" vision
- Difficulty reading or performing tasks that require seeing detail
- Gray area in central vision
- Central blind spot
Causes:
In very rare instances, trauma or other conditions lead to the development of a macular hole. In the vast majority of cases, however, macular holes develop spontaneously. As a result, from traditional thinking there is no known way to prevent their development through any nutritional or chemical means, nor is there any way to know who is at risk for developing a hole prior to its appearance in one or both eyes.
Treatment:
An operation, called a vitrectomy, can be performed to help limit the eye problems that a macular hole causes. The macula needs to lie flat on the back of the eye to receive, through blood vessels, all the nourishment it needs to work properly. The surgery is an attempt to help the macula lie flat on the back of the eye. If this is successful then often sight problems can be helped.
There are two main stages to the eye treatment:
- Surgery to remove the vitreous and insert gas into the eye (vitrectomy)
- A recovery period when the gas smoothes the retina back flat onto the eye
The vitrectomy operation can be performed under local anaesthetic. During the operation the vitreous is removed to prevent it from pulling on the retina. It is replaced with a gas bubble that eventually gets reabsorbed and replaced by the natural fluids of the eye. The gas is inserted to help the macular hole heal in the correct place. This gas is lighter than air so it floats upwards. The gas acts like a bandage pressing the macula hole flat onto the back of the eye, repairing the hole and making sure that there is no risk of further damage or retinal detachment.
To make sure that the gas is putting pressure on the correct part of the retina, it is usually necessary for the patient to have their head positioned face downwards. The gas puts a small amount of pressure on the macular hole which encourages the hole to close and repair itself. The correct posture is important because it makes sure that the pressure is applied in the right place. This part of the eye treatment process is often just called "posturing". Normally people have to posture for between seven to ten days, although some ophthalmologists are now recommending shorter periods. During this time the gas bubble is slowly being reabsorbed by the body - this usually takes six to eight weeks. As this happens the space that was taken up by the gas is replaced by aqueous fluid - the natural fluid made by the eye.
Vitrectomy can lead to complications, most commonly an increase in how fast cataracts develop. Other less common complications include infection, bleeding and retinal detachment either during the eye surgery or afterward.
Typically, for macular holes less than six months in duration, a vision improvement of approximately three lines on the eye chart (or 50% improvement) can be achieved. Obviously, this is an "average" visual improvement. Vision recovery varies on a patient-by-patient basis, and each patient must be evaluated on an individual basis and discuss with their surgeon the expectations for visual recovery. Some patients achieve only a small amount of vision recovery, while others achieve a more significant improvement after this eye treatment.
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