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Treatment
Macular Hole Surgery
Macular hole surgery is performed by using a technique known as “vitrectomy surgery”. Please see the section on vitrectomy surgery for a basic description of the procedure. Macular holes are caused by tissue in the eye which contracts and pulls a hole in the central retina, known as the macula. Tissue on the surface of the retina then gradually pulls the hole open causing a blind spot and distortion in the center of vision. The purpose of macular hole surgery is to remove the tissue which is causing hole formation and to then allow the hole to slide closed by using a gas or oil bubble injected into the eye during surgery. This may work by pressing the hole closed or by keeping the fluid inside the eye away from the hole while it is healing.
There are a number of different techniques that retina surgeons around the nation use for this. Although most or all surgeons use a gas or oil bubble inside the eye, some surgeons require prolonged facedown positioning after the surgery and some use techniques that require dissolvable stitches to be placed in the eye following surgery.
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Our preferred technique is to avoid prolonged facedown positioning after the surgery and to use a sutureless vitrectomy procedure. After the surgical procedure is performed, we ask that patient’s avoid looking up and try to keep their eyes at or below the horizon for 1 week following surgery. This allows patients to maintain a relatively comfortable position most of the time for the first week following surgery. Patients can lift their head to a horizontal position in order to walk from room to room, eat and perform normal hygienic activities. However, the preferred position for the first week after surgery is to keep the chin on the chest or to lay down with the nose tilted toward the floor. After the first week there is no required positioning, but we do suggest that patient’s avoid lying flat on their back for approximately 2 weeks. Using this technique, we have had a surgical success rate above 90%, which is consistent with all other reported surgical techniques.
The outcome of the surgery can depend on a number of different factors. One is the duration of the macular hole. Macular hole surgery provides the best outcome if it is performed within a few months following the formation of the hole. Patients that have had a macular hole for a year or longer have a significantly lower chance of regaining good vision. The visual outcome also depends on the size of the macular hole and how much retinal tissue has been removed from the macula during the process or formation of the macular hole. Patients can achieve very good vision following macular hole surgery, but visual outcomes can vary. In general, however, most patients will see a significant improvement in vision of several lines of vision on the eye chart. Postoperatively, there can be persistent visual distortion, blind spots, and blurred vision, which may not be correctable with glasses.
Patients that have never had cataract surgery are at risk for developing a cataract, which may require surgical removal to achieve the best visual outcome.
As with any surgical procedure there are risks associated with this surgery, but most of the risks are uncommon. The most common risk is a cataract forming in patients that have not had previous cataract surgery. Other risks can include a postoperative wound infection, retinal detachment, intraocular bleeding, glaucoma, and even loss of the eye. However, it must be kept in mind that the likelihood of the vision improving in the eye without surgery is extremely unlikely.
Please see the video links which describe the various surgical procedures for specific disease conditions