Macular hole treatment
Macular hole treatment
What is a Macular Hole?
The eye is like a camera with a lens in the front and film in the back of the eye. The retina is the light sensitive film at the back of the eye and the macula is the mostimportant part of the retina, responsible for sharp central vision like reading, driving and focusing objects. A macular hole is the development of a small hole in the centre of the macula.
“Macular holes and macular degeneration are different conditions although they affect the same area of the eye’’
What causes macula hole?
We do not know why macula holes develop, but it is probably caused by the vitreous jelly pulling the central macula. However, they tend to occur is patients over 60 years old and it typically affects women more than men. Other causes include trauma, being long-sighted and very short-sighted,those who have had other retinal problems.
What are the symptoms?
Macula is the important area on the retina responsible for sharp central vision. A hole on the macula causesdistorted and blurred central vision, straight line may appear bent and sometimes a patch of missing vision in the centre. These symptoms become obvious when good eye is covered.
‘’ if untreated the central vision may get worse even to read large prints like ‘’Big E’’ on the eye chart’’
Though macular hole can be diagnosed by clinical examination, it is necessary to do OCT scan of retina, to get intricate details of macular hole to advice about the surgical outcome. Mr Viswanathan has access to the state-of-the-art retinal scanner to investigate the macular hole.
What is the treatment for macular hole?
The only definitive intervention to treat a macular hole is to do an operation called vitrectomy. Some patients accept the poor central vision and choose not to have surgery. Not having an operation is also an option as there is no right or wrong decision as everyone has different priorities and requirements. You can discuss your decision with Mr Viswanathan regarding whether to have or not to have an operation for macular hole.
OCT scan of healthy Macula
OCT scan of macular hole
Macular hole Surgery – Sutureless Surgery
Macular hole is treated by an operation called vitrectomy. This involves a surgical procedure whereby the vitreous jelly is removed (Vitrectomy) from inside the eye to gain access to the macular hole, then a delicate layer (Inner limiting membrane) is carefully peeled off around the macular hole to stop the tractional forces that keep the hole open. The eye is then finally filled with a temporary gas bubble,which takes about 4 weeks to dissolve on its own.
The vitrectomy surgery is performed through three key-holes in the eye which does not require suturing. This surgery can be performed under local or general anaesthesia as a day case procedure which usually takes about an hour. If there is a cataract along with macular hole, then cataract is also removed at the same time as a single procedure during macular hole surgery.
How successful is the operation
Macular hole surgerysuccess rate for Mr Viswanathan is more than 90% chance of hole closure following vitrectomy. Majority of patient with macular hole closure following surgery notice improved vision with a decrease in visual distortion. Much of the visual improvements occurs in the first few weeks and this can take up to 6 months. It is to be noted that for majority of patients even with successful hole closure, vision will not be as good as it was prior to the occurrence of macular hole and rarely vision can be worse after surgery.
What is gas bubble and face-down posturing
With a gas bubble in the eye, your surgeon may ask you to posture after the operation for up to 7 days. Posturing involves placing your head in a face-down position to allow the gas bubble to float into the best position to be in contact with the hole to encourage it to close. You will be required to posture up to 45 - 50 minutes of every hour during the day. The remaining time of every hour can be spent moving around as normal. You must not fly or go high altitude until the gas bubble disappears. The gas bubble left inside the eye will take about 4 weeks to dissolve on its own.
What if I cannot maintain a face-down position
Though keeping face-down after macular hole surgery is an established and proven practice, many studies have shown that posturing is not essential and if you have difficulties with adopting the correct position then it is possible to have a successful outcome, although closure rates are slightly lower. Maintaining face-down position gives your macula the best chance to be successfully treated. There are a number of devices that can make the “face-down” recovery period easier on you. You can discuss this with Mr Viswanathan.
Where can I find further information?
Understanding macula hole surgery can be complicated. This information leaflet may not cover all the concerns you may have about this procedure. Further information can be found at the following websites:
https://www.nhs.uk/conditions/macular-hole/
https://www.rnib.org.uk/eye-health/eye-conditions/macular-hole
Information leaflet downloads
Macular Hole Leaflet Amsler Grid leaflet
Scientific Evidence
The information mentioned here is based on a variety of sources, including latest published research and the Britain & Eire Association of Vitreoretinal Surgeons.
Disclaimer
It is impossible to diagnose and treat patients without complete eye examination by an ophthalmologist. I hope the above information will be of help before and after a consultation which this information supplements and does not replace. This information must not be used as a substitute for professional medical care by a qualified doctor or other health care professional.
If you have any concerns about your condition or treatment, please ask your surgeon Mr Viswanathan. We are not responsible or liable, directly or indirectly, for ANY form of damages whatsoever resulting from the use (or misuse) of information contained in this page or found on web pages linked to from this page.