| What can be done for a macular hole?
Up until only a few years ago, there was nothing that could be
done to alter the status of a macular hole. There is now a surgical procedure performed
that involves removing the vitreous gel from the eye so that it is no longer pulling on
and distorting the macula. The vitreous gel is replaced with a bubble containing a mixture
of air and gas. The purpose of the bubble is to act as an internal, temporary bandage that
holds the edge of the macular hole in place as it heals. In order to maximize the effect
of the bubble, you will be requested to maintain face down or prone position. The bubble will be gradually reabsorbed
by the eye during a 4- to 8-week period following surgery. As the bubble is reabsorbed,
the vitreous cavity refills with a naturally produced fluid.
Drs. Greve and Hinz may recommend surgical intervention to try and
repair the macular hole. Surgury involves a vitrectomy to remove the vitreous traction on the hole, removal of any associated epiretinal membrane, and injection of C3F8 gas which provides
pressure inside the eye to close the macular hole.
What can I expect following surgery?
You should remain in a "face-down" position for as close
to 24 hours per day as is possible for the first 2 weeks after surgery. These specific
instructions may be modified by Drs. Greve and Hinz. Click
to see Prone or Face down instructions.
The bubble will remain in your eye approximately 4 to 8 weeks. Vision
will be markedly reduced immediately after surgery since you cannot see well through the
bubble. The bubble will gradually reabsorb and be replaced by normal ocular fluids. As the
bubble reabsorbs you will gradually see more and more. You should not, however, expect to
experience significant improvement in vision until at least 6 weeks after surgery, and it
is not uncommon for vision to continue to improve for many few months following surgery.
You may not fly in an airplane until the bubble shrinks to a size that fills 10% of the
vitreous cavity. This usually occurs about 6 weeks following surgery, but it is a good
idea to have your eye doctor check on the size before flying for the first time. Also,
general anesthetic agents must be avoided.
As the bubble shrinks, you will begin to notice a fluid level when
looking through the operated eye. This level will gradually change with time. Often,
satellite bubbles will form, giving the appearance of fish eggs or small balloons when you
look through the operated eye. This is normal and is no cause for alarm. It is common for
patients to experience mild irritation for a few days after surgery, but severe pain is an
indication to call your surgeon immediately. The eyelids are usually swollen for the first
couple of weeks, but this gradually resolves thereafter. The patch is only for comfort and
can usually be discontinued after 3 or 4 days. It is a good idea to continue using
the
shield to protect your eye while sleeping for about 4 weeks.
The goal of the surgery is to flatten the edges of the macular hole and
improve your vision.
What are the risks of the procedure?
There are always risks associated with surgical procedures. A retinal detachment occurs in about 3% of patients is usually
treatable with further surgery, often with little of no adverse effect on your final
vision. The
intraocular pressure is transiently elevated in about 20% of patients. This is usually
well controlled with eye drops, and almost always resolves with time as the
gas bubble dissipates. However, the
inconvenience of additional office visits or medical therapies may be necessary. The most
severe complications occur extremely unfrequently: the risk of severe hemorrhage,
infection or anaesthesia complications (retrobulbar or general anaesthetic)
during vitrectomy surgery occurs in approximately one in several thousand cases.
This is about the same risk as getting killed in a car accident driving to
Calgary. These
complications could result in irreversible blindness or death.
The most common risk following macular hole surgery is cataract
development. Really, this is more of a side effect than risk because the gas
bubble causes cataract, regardless of the
underlying diagnosis. It begins to develop in almost all patients by 6 to 1 2 months after
surgery. It usually becomes severe enough to require removal, but not always. If
necessary, it can be surgically removed in the future, and if indicated, an intraocular
lens can be implanted.
What follow-up is necessary?
For the benefit of the patient, it is important to monitor the
status of the eye following surgery. We usually see the patient one day, 1-2
weeks, 6-8 weeks,
and then 3 or 4 months after surgery. These may be modified by Drs. Greve and
Hinz. |
