Vision Scotland : Everything you need to know

Macular holes

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surgery for macular holes at vision scotland in edinburgh

Surgery for full thickness macular holes

A macular hole is a relatively common problem with the retina that makes objects at the centre of your vision seem blurry or distorted. Straight lines like the edges of doors or windows may also appear bent. Macular holes can be treated with keyhole surgery, which encourages the Macular hole to close.

What is a macular hole?

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.

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what is a macular hole
vision scotland surgeon jonathan ross

What does the surgery involve?

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.

What are the benefits of surgery?

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.

surgery benefits
risks of surgery

What are the risks of surgery?

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:
  • The development of a cataract is common after this type of operation but it can be treated easily with standard cataract surgery
  • A retinal tear or detachment
  • A mild or severe infection inside the eye
  • Complete loss of sight (less than 1:1000 chance)
  • In some cases, a gas bubble is inserted into the back of the eye to support the retina. In even fewer cases, this bubble may cause pressure in the eye which can cause damage if not treated.

After the operation

The surgery is considered low risk and low impact, but your eye may feel uncomfortable, gritty, and itchy for a week or two. It may also look red or bruised. Regular pain relief is usually enough to treat the discomfort. You will receive eye drops to reduce inflammation and prevent infection, but patients are also advised not to rub or touch the eye as this can introduce an infection. Your eye will heal over the course of six weeks, but your vision might continue to improve for several months. Following the operation, the vision in the operated eye will be very poor because there is a gas bubble in your eye. As the gas bubble disappears downwards you will begin to see over the top of the bubble. In rare cases (10%) you may be asked to posture in order for the gas bubble to press on the macula. If this is required your surgeon will instruct you after the operation to sit or lie with your head face down. This is usually needed for 5 days.
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what does the surgery involve
eye examination after surgery

After the operation

The surgery is considered low risk and low impact, but your eye will feel uncomfortable, gritty, and itchy for a week or two. It may also look red or bruised. Regular pain relief is usually enough to treat the discomfort.

You will receive eye drops to reduce inflammation and prevent infection. Your eye will heal over the next 6 to 8 weeks but your vision might continue to improve for several months following the surgery. If a retinal tear develops during surgery your surgeon may put a bubble of gas inside your eye to stop the retina from detaching. In this case you may have to posture with your head in a certain position, and your vision will be blurry until the gas disappears.

You must not fly until the gas has disappeared as the bubble will expand and damage your eye. You must also not have nitrous oxide anaesthetic for the same reason. It is normal to have some discomfort after any operation, but you should contact Vision Scotland should you have any concerns.

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Vision Scotland : Eye care specialists

Why have treatment with Vision Scotland 

Surgery

All surgery is carried out by the same surgeon you see in consultation.

Experience

Our surgeons are all highly experienced with more than 10+ years’ experience in refractive surgery.

Nursing

Experienced, caring nursing and optometrist team.

Approved

HIS approved purpose-built facilities.

Equipment

State-of-the-art diagnostic and surgical equipment.

Support

Robust, extended aftercare plans as part of package.

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