Open in a separate window. Figure 1. Results There were four patients of which three were males and one patient was female. Table 1 Demographic profile of patients and details of recurrent macular holes. Figure 2. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. References 1. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. Types of macular hole closure and their clinical implications.
Br J Ophthalmol. Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery. Indian J Ophthalmol. Retreatment of full-thickness macular hole: Predictive value of optical coherence tomography.
Closure of chronic macular holes using passive aspiration to the edges of the macular hole. Ophthalmic Surg Lasers. Re-operation of idiopathic full-thickness macular holes after initial surgery with internal limiting membrane peel.
Internal limiting membrane removal during macular hole surgery: Results of a multicenter retrospective study. If you need a general anaesthetic while the gas is still in your eye, it's vital you tell the anaesthetist so they can avoid certain anaesthetic agents that can cause expansion of the bubble. You probably won't be able to drive for 6 to 8 weeks after your operation while the gas bubble is still present in your eye.
Speak to your specialist if you're unsure. You'll notice the bubble shrinking and will be aware when it has completely gone. Most people will need some time off work, although this will depend to an extent on the type of work you do and the speed of recovery. Discuss this with your surgeon.
It's unlikely you'll suffer harmful effects from a macular hole operation. The hole may fail to close, but this normally won't have made your vision any worse, and it's usually possible to repeat the surgery.
You'll almost certainly get a cataract after the surgery, usually within a year if you've not already had a cataract operation. This means the natural lens in your eye has gone cloudy. If you do already have a cataract, it may be removed at the same time the hole is being repaired.
Retinal detachment is when the retina detaches from the back of the eye. This can potentially cause blindness, but it's usually repairable in a further operation. Bleeding occurs very rarely, but severe bleeding within the eye can result in blindness.
Infection is also very rare, occurring in an estimated 1 in 1, patients. An infection needs further treatment and could lead to blindness. An increase in pressure within the eye is quite common in the days after macular hole surgery, usually due to the expanding gas bubble. In most cases, it's short-lived and controlled with extra eye drops or tablets to reduce the pressure, protecting the eye from damage.
If the high pressure is extreme or prolonged, there may be some damage to the optic nerve as a result. The most important factor in predicting whether the hole closes as a result of surgery is the length of time the hole has been present. Most people have some improvement in vision after they've recovered from the surgery.
At the very least, the operation usually prevents your sight from getting any worse. Your doctor will speak to you in more detail about what results you can expect from the surgery. Even if surgery does not successfully correct your central vision, a macular hole never affects your peripheral vision, so you'd never go completely blind from this condition.
After carefully examining your other eye, your surgeon should be able to tell you the risk of developing a macular hole in this eye. In some people this is extremely unlikely, in others there's a 1 in 10 chance of developing a macular hole in the other eye. It's very important to monitor any changes in the vision of your healthy eye and report these to your eye specialist, GP or optician urgently. A macular hole is not the same as macular degeneration, although they affect the same area of the eye and can sometimes both be present in the same eye.
AMD is damage to the macula leading to the gradual loss of central vision. It's unclear what causes it, but getting older, smoking and a family history of the condition are known to increase your risk.
Page last reviewed: 05 August Next review due: 05 August Surgery is performed under local anesthesia and often on an out-patient basis. Following surgery, patients must remain in a face-down position, normally for a day or two but sometimes for as long as two-to-three weeks. This position allows the bubble to press against the macula and be gradually reabsorbed by the eye, sealing the hole.
As the bubble is reabsorbed, the vitreous cavity refills with natural eye fluids. Maintaining a face-down position is crucial to the success of the surgery.
Because this position can be difficult for many people, it is important to discuss this with your doctor before surgery. The most common risk following macular hole surgery is an increase in the rate of cataract development.
In most patients, a cataract can progress rapidly, and often becomes severe enough to require removal. Other less common complications include infection and retinal detachment either during surgery or afterward, both of which can be immediately treated. For a few months after surgery, patients are not permitted to travel by air.
Changes in air pressure may cause the bubble in the eye to expand, increasing pressure inside the eye. Vision improvement varies from patient to patient. People that have had a macular hole for less than six months have a better chance of recovering vision than those who have had one for a longer period. Discuss vision recovery with your doctor before your surgery. Vision recovery can continue for as long as three months after surgery.
If you cannot remain in a face-down position for the required period after surgery, vision recovery may not be successful. In the initial stages, macular holes cause blurred and distorted vision. Many patients complain of trouble reading the small print, and straight lines appear to look wavy or bowed.
Macular holes can occur due to:. OCT scan of lamellar macular hole. Post-operative OCT scan of the same patient with lamellar macular hole. Usually, to treat full-thickness macular holes, surgery is needed. This surgery is often successful and can help prevent further vision loss.
In many cases, vitrectomy has resulted in improved vision. The macular surgery involves removal of the vitreous jelly vitrectomy which helps to stop it from pulling on the retina. After removing the vitreous internal limiting membrane acellular superficial basement membrane of the retina surrounding the macular hole is peeled to relieve the pulling forces traction causing the macular hole to form and enlarge. At the end of the surgery, the vitreous cavity is filled with special long-acting gas.
The surface tension of the gas bubble helps in closing the macular hole. The macular surgery is done under the influence of local anesthesia and following the procedure patient is expected to stay in a face-down position.
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