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The retina in your eye is similar to the photographic film in a camera, composed of multiple layers of nerve cells. The function of the retina is to turn images of the outside world into signals, which are then transmitted to your brain. The macular is located at the centre of the retina and has the important function of providing you with high definition vision – for things like reading and recognising faces. A macular hole is a defect that goes all the way through the retina, at this very location.
Patients with a macular hole will experience blurring of close up objects, and straight lines like doorways may also appear curved or bent. For some, particularly in the early stages of a hole developing, the symptoms are subtler, and it will only be noticeable when one eye is closed. It is a condition where time is of the essence for treatment, because as the hole gets bigger, so the surgical success rate in closing it gets smaller.
It is unclear why macular holes form. However, there are risk factors for their formation and these include age, female sex, and short-sightedness.
Treatment for macular holes requires keyhole surgery to the eye. The operation is typically performed under a local anaesthetic. During the operation the surgeon removes the gel from inside the back of your eye as well as the inner limiting membrane which pulls on the retina. A bubble of gas is then placed inside the eye to encourage the macular hole to close.
Sometimes the surgical openings are closed with a small stitch at the end of the operation, but these dissolve after 4 to 6 weeks. You will usually have a pad and shield over your eye after the operation which is removed the next day.
Surgery is very successful and overall 90% of macular holes close with a single operation. Most patients find that surgery either improves their vision or stops it from getting worse, however, the quality of vision is never as good as it was before the macular hole, even if the operation is successful.
Small macular holes that are detected early tend to fair much better than large holes that may have gone undetected. It is for this reason, prompt diagnosis and surgery provide your eye with the best chance to preserve vision.
Just like any surgery, macular hole surgery carries some risks, but it is generally considered the lowest risk alternative to leaving it untreated. Macular holes result in irreversible central vision loss and so you consultant eye surgeon will advocate surgery.
We do routinely see all patients at two weeks post-surgery to monitor for complications, including:
Injection for wet AMD is a relatively new treatment. Like all medical procedures, there are risks as well as benefits. Although a rise in pressure within the eye is expected immediately after the injection, occasionally an incision is required to release fluid from the eye if the pressure is too great.
After macular hole surgery, your eye may feel uncomfortable, gritty, or itchy for a week or two, and it may look red or bruised. This is normal and usually settles with simple pain relief. Your eye will heal over 6–8 weeks, although vision can continue to improve for several months.
Some patients may have a gas bubble placed in the eye, which affects vision temporarily and may require specific aftercare.
You will be prescribed eye drops to reduce inflammation and prevent infection. It is important not to rub or touch your eye, as this can increase the risk of infection.
In some cases, a gas bubble is placed inside the eye to support the retina. While the gas is present, vision in the operated eye will be very poor. As the gas bubble gradually disappears, you will begin to see over the top of it and vision will slowly improve.
In a small number of patients (around 10%), you may be asked to posture so the gas bubble presses against the macula. If required, your surgeon will give clear instructions after surgery. This usually involves sitting or lying face down for about five days.
Some discomfort is normal after surgery, but if you have concerns or notice worsening pain, redness, or vision, you should contact Vision Scotland for advice.
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