Macular hole surgery

.A macular hole can often be repaired with a procedure called vitrectomy, peeling and gas. If the hole has been present for less than a year, the operation will be successful in closing the hole in about 90% of cases. Of these, more than 70% will be able to see two or three lines more on a standard visual acuity chart, compared to before the operation. Even if this degree of improvement is not achieved, vision is at least stabilized and many patients find that they have less distortion. In a minority of patients the hole does not close despite surgery and central vision may continue to deteriorate. However, a second operation may still be successful in closing the hole.It is important to understand that a return to completely normal vision is not possible.

If I wish to undergo surgery, does it matter how long I have had the macular hole?

There is evidence that relatively early treatment (within months) offers better results in terms of improving vision. Studies have shown, however, that it may be possible to improve vision in some patients with long-standing macular holes.

What does the surgery involve?

Macular hole surgery is performed under a microscope, using 3 small incisions (1-2 millimeters in size) in the white of the eye to insert very thin instruments. First, the "jelly" is removed from the inside of the eye (vitreectomy) and then a very thin layer (the internal vitreous humor) is carefully removed from the surface of the retina around the hole to release the pulling forces that hold the hole open.

The eye is then filled with a temporary gas bubble, which presses against the hole to help it close. The gas bubble blocks vision for as long as it remains in the eye, but it slowly disappears over about 2-8 weeks. At the end of the procedure, we may place a dressing over your eye to protect it and reduce swelling.

How long does the surgery take and do I need general anesthesia?
Macular hole surgery usually takes 45-90 minutes and can be done with the patient awake (local anesthetic) as a day procedure. so that no pain is felt during the surgery.

After the operation if you have any discomfort, we recommend taking a painkiller, such as paracetamol or ibuprofen, every 4-6 hours. It is normal to feel itchy, sticky eyelids and mild discomfort for a while after the operation. It is common for the eye to water. Occasionally, the area surrounding the eye may swell. Any discomfort should subside after 2-3 days. Try to rest while your eye recovers. We will give you eye drops to reduce any inflammation and prevent infection. We will explain how and when to use them. Please do not rub your eye.
Some symptoms may mean that you need immediate treatment. Contact the clinic immediately if you have any of the following symptoms:
– Severe pain 

Vision loss

Redness

Do I have to keep my head down after the surgery?

The aim of the face-down position is to keep the gas bubble in contact with the hole as much as possible. Your head should be positioned so that the tip of your nose is pointing straight down to the ground. This could be done either with your forehead resting on a table (a horseshoe-shaped pillow or frame may help with this) or by lying on your stomach ('prone') on a bed or sofa. You should aim to remain in this position for 50 minutes every hour, for the recommended duration (usually 2-5 days after surgery). A short break of 10-15 minutes can be taken every hour to allow for eating, bathing etc. 

Can I travel after macular degeneration surgery?
You should not fly or travel at high altitude while the gas bubble remains in the eye (2-8 weeks).

Additionally, if you require general anesthesia while the gas is in your eye, then it is very important to inform the anesthesiologist of this fact so that they can avoid certain anesthetic agents that may cause similar gas expansion. None of these exceptions apply once the gas has been fully absorbed.

How long will I need to take off work?

Most people need two weeks off work. Your vision is limited while the gas bubble is in the eye and this also affects depth perception. However, it depends on the type of work you do. This should be discussed with your surgeon.

What are the possible complications of macular hole surgery?
In a small minority, vision may end up worse than before surgery and there is even a small chance of complete vision loss. Six specific complications of macular hole surgery that you should be aware of are outlined below:

1. Failure of the macular hole to close: this occurs in 1-2 out of 10 patients. In most cases, it is possible to repeat the surgery. If the hole fails to close, then vision may be slightly worse than before surgery.
2. Cataract: this means that the natural lens in the eye has become cloudy. If you have not already had cataract surgery, you will almost certainly develop a cataract after surgery, usually within a year, but this can happen very quickly.
3. Retinal detachment: the retina detaches from the back of the eye in 1-2% of patients undergoing macular hole surgery. The vast majority of these can be repaired, but further surgery is required.
4. Bleeding: this happens very rarely, but can be serious. Please let us know if anticoagulants are used
5. Infection: this is also very rare and is expected to occur in about 1 in 1000 patients, but if this occurs it requires further treatments.
6. Increased pressure: An increase in pressure within the eye is quite common in the days following macular hole surgery, usually due to the expanding gas bubble. In most cases it is short-lived and controlled with additional eye drops and/or tablets preventing further damage to the eye. If the high pressure is extreme or prolonged, there may be some damage to the optic nerve as a result. In the majority, this damage does not adversely affect vision, but some patients require long-term treatment to keep the eye pressure under control.

Will I need to use eye drops or medication after surgery?
Two types of drops are usually given after surgery: an antibiotic, and a steroid. If eye pressure increases after surgery, additional drops and/or tablets may be prescribed to treat it.

Will I need to change my glasses?

Most people will need to change their eyeglass prescription at some point after surgery. This is usually around 3 months after surgery, after the gas bubble has absorbed. As each case is different, please consult your surgeon before visiting an optician.