Macular hole
What is the treatment and how successful is it?
Vitrectomy surgery
A macular hole can often be repaired using an operation called a vitrectomy, withinner limiting membrane (ILM) peel and gas.
If you've had the hole for less than a year, there's around a 90% chance the operation will be successful in closing it. More than 70% of people successfully treated will be able toread two or three additionallineson a standard vision chart, comparedto before the operation.
Even if surgery does not achieve this degree of improvement, your vision will at least become stable, andyou mayfind you have less distortion of vision.
In a minority of patients, the hole doesn't close despite surgery, and the central vision can continue to deteriorate. However, a second operation can still be successful in closing the hole.
Ocriplasmininjection
If a macular hole is caused by vitreomacular traction, it may be possible to treat it with an injection of ocriplasmin into the eye. The injection helps the vitreous jelly separate from the back of the eye and allows the macular hole to close. This treatment is successful at closing a macular hole in around 40% of cases.
The injection takes a few seconds and you'll be given local anaesthetic aseye drops or an injection, so you won't feel any pain. You'll alsobe giveneye drops to dilate your pupil, so the ophthalmologist can see the back of your eye.
An ocriplasmin injection is usually only available in the early stages, while the macular hole is less than 400 micrometres wide, but causing severe symptoms.
Ocriplasmin can cause some mild side effects, which usually go away,such as:
- temporary discomfort
- floaters
- flashing lights
- dimming of vision
- yellow tinge to the vision
Asmall number of people may develop more severe side effects, such as a noticeablelossof vision, enlargement of the macular hole or retinal detachment. Surgeryisusuallyneeded to correct macular hole enlargement or retinal detachment.
You won't be able to drive after the injection, as the eye drops cause your vision to be blurry. However, you should have normal, comfortable vision the day after.
If the ocriplasmin injection fails to close the macular hole, which happens in around 60% of cases, vitrectomy surgery will be needed to close the macular hole and improve the vision.
Medically Reviewed by a doctor on 21 Dez 2018
Introduction
A macular hole is a small gap that opens up at the centre of the retina in the macula. It causes blurred and distorted vision, and can be treated with surgery.
Why does it happen?
We don't know why macular holes develop. The vast majority of cases happen spontaneously (without an obvious cause). They most often affect people aged 60-80, and are twice as common in women as men.
What should I do?
If you have blurred or distorted vision, or there's a black spot in the centre of your vision, see your GP or optician as soon as possible. You'll probably be referred to an ophthalmologist (a special
What is the treatment and how successful is it?
Vitrectomy surgery A macular hole can often be repaired using an operation called a vitrectomy, withinner limiting membrane (ILM) peel and gas. If you've had the hole for less than a year, there's a
What does vitrectomysurgery involve?
Macular hole surgery is a form of keyhole surgery performed under a microscope. Three small incisions (one millimetre in size) are made in the white of the eye and very fine instruments are inserted.
macular-hole-expect-operation
Temporary poor vision With the gas in place, the vision in your eye will be very poor a bit like having your eye open under water. Your balance will be affected and you'll have trouble judging dista
Do I need to position myself face down after the operation?
Once at home, you may have to spend several hours during the day with your head held still and in a specific position, called posturing. The aim of lying or sitting face down is to keep the gas bubbl
Am I able to travel after macular hole surgery?
You must not fly or travel to high altitude on land while the gas bubble is still in your eye (up to 12 weeks after surgery). If you ignore this, the bubble will expand at altitude, causing very high
What if I need another operation shortly after my treatment?
Ifyou 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.
Can I drive after the operation?
No the gas bubble will still be present in your eye for six to eight weeks after your surgery, so during this time you can't drive a vehicle of any sort. None of these exclusions apply once the gas h
How much time will I need off work?
Most people will need at least two weeks off work, although this will depend to an extent on the type of work you do and the speed of recovery. Discuss thiswith your surgeon.
What are the possible complications of macular hole surgery?
It's unlikely that you'll suffer harmful effects from a macular hole operation. However, you should be aware of these six possible complications: Failure of the hole to close. This happens in 1-2
How successful is macular hole surgery?
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. If you've had a holefor less than six months, there's about a90
Can I develop a macular hole in my other eye?
After carefully examining your other eye, your surgeon should be able to tell youthe risk of developing a macular hole in this eye. In some people this is extremely unlikely, in othersthere's a1 in 1
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