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Information on Macular Holes
MACULAR HOLE
Macular hole is a full thickness defect of the retina in the central vision area called the macula. It occurs more commonly in women than men. It is usually the result of the vitreous gel pulling on retina. Without treatment the reading and distance vision will develop a missing area of vision in the center of the vision. The peripheral vision almost always remains strong except in cases of patients with very high myopia.
The treatment for macular holes is a vitrectomy with injection of a large gas bubble into the eye. This surgery closes the macular hole 80-90% of the time. The success of the surgery is also dependent on the patient’s ability to position with their face down after surgery for a week to 10 days. This face down positioning puts the bubble up against the macular hole and helps close the hole.
The gas bubble blocks the vision out of the eye and limits the examination into the eye for about 4 to 5 weeks. Approximately 5 weeks after surgery, the gas bubble has usually been reduced in size to determine if the surgery has been successful in closing the macular hole. If the hole is closed, the vision starts to improve, but vision usually continues to gradually improve for 4 to 8 weeks as the bubble shrinks and eventually disappears.
WHEN THE GAS BUBBLE IS IN THE EYE THE PATIENT IS NOT ALLOWED TO TRAVEL TO HIGH ALTITUDES (OVER 2000 FEET) OR FLY IN AN AIRPLANE
Vitrectomy and injection of a gas bubble commonly cause cataracts to develop if they are not already present. Because of this fact, we commonly perform cataract surgery at the time of vitrectomy to repair the macular hole. This method has proven to be safe and allows patients to get back to their regular life without further cataract surgery in the future. We will sometimes leave the lens in and not do cataract surgery in younger patients who are less likely to develop a cataract after the vitrectomy for macular hole.
It is usually necessary to be fit for new glasses 9 to 12 weeks after surgery to achieve the best possible vision. Vision can improve slowly in some patients for up to 2 years after the surgery.
Macular hole surgery is successful 80 to 90% of the time with one operation. If the operation fails, another surgery is usually successful in closing the macular hole. About 5% of patients will develop retinal detachment from the surgery and require further surgery to fix this problem. Loss of vision can occur due to this complication. Rare complications such as infection or hemorrhage can cause total loss of vision and rarely patients can lose their eye.
Although vision improves in most patients, it is usually not completely back to normal. Distortion and decreased vision not infrequently remain in many patients.
FAQ about Macular Hole
What causes macular holes?
Macular hole occurs more commonly in women than in men. It appears to be due to the vitreous gel pulling on the macular area and causing the hole to open. Other causes include trauma and high myopia.
How soon should I have surgery?
Macular hole is not an emergency. If an important trip is already planned in the next few months, we recommend having surgery within 2 to 4 months after diagnosis. If a patient waits for a long period of time to have surgery (over a year), the visual results and success rates for the surgery may not be as good.
Should I rent a massage table or special equipment to help me position and keep my head down?
If you think this will help you position you may pursue this. Kaiser cannot reimburse you for the rental of this equipment, and we have found that some patients who rent the equipment feel it has helped them a lot, and others are not so impressed. We have not noticed a difference in success rates between patients who have rented the equipment, and those who did not. This decision is entirely up to you.
Can I read while I am keeping my head down or work on the computer?
After the first postoperative day it is OK to read or do computer work as long as your head remains down and the eye is pointing to the ground.
What is the chance of having a macular hole in the other eye?
Published studies site the chance of developing a macular hole in the other eye as being between 2 to 12%.
How long until I see better?
The entire healing process is usually through after 12 weeks. Remember, the vision will not be like it was before the hole developed in most cases, but it will be improved in most. It is usually best to wait to get new glasses (if cataract surgery was also done) for at least 8 to 10 weeks. Right after the surgery, the vision will be very poor due to the gas bubble in the eye.
What are the most common risks of this type of surgery?
Retinal detachment (5%) which can be repaired with more surgery in most cases,
Recurrence of the macular hole occurs in about 2-5% of cases.
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