Macular Hole

Macular Hole

The macular hole is a disease that affects the Macula, a one to two millimetre area located in the center of the retina. It is here that we find the largest concentration of visual cells; this is why the macula region is responsible for fine vision skills, such as reading, writing or driving, the surrounding areas of the retina are responsible for the rest of the visual field.

In your case; tangential traction has created a hole in your macula. Somewhat quickly, this hole is growing in size and the hedges are detaching. This is accompanied by a decrease in central visual acuity, which without intervention will become in the majority of cases irreversible. You are falling down the stairs of visual health without hope of returning to the top. The goal of the procedure is to close this hole, in order to stop the visual loss, and perhaps even lead to small improvement.

In the majority of cases your surgeon will proceed in the following manner. After having performed a vitrectomy, a procedure where the vitreous gel is scooped out with a vitrectomy machine, and then replaced with a substitute liquid, the surgeon will then remove the posterior hyaloid, the envelope of the vitreous, attached to the retina. To aide in the healing of the hole, the doctor will then remove the internal limiting membrane of the retina in the entire posterior region. This is a film a few microns thick, that is ten times thinner than a strand of hair. The doctor will need to inject a bubble of gas into your eye to push down on the sides of the hole. This bubble of gas, adhering to Archimedes’s Laws, will rise. If you want the bubble to push on the macula and your recovery to go well, you will have to put your macula toward the top, that is to say you need to look down, toward the ground, below your head. This is what we call “the bubble position”.

You can go home by either car or train. You will need to be seated and looking directly at your heels.

As soon as your leave the clinic, eye drops will have to be administered to your eye. The doctor will give you the specifics of your prescription; including the frequency and duration of treatment, right before you leave the clinic.

You will be able to take off the eye patch the day after your operation, but your operated eye wont be able to see because of the gas bubble.

You will need to maintain “the bubble position” between three and eight days. This can be difficult to maintain as it can result in neck and shoulder discomfort. During the day, most patients choose a seated position next to a table, the head placed on the arms, or on a pillow. You are allowed to read if your book is placed below your head and you can walk as long as you stare at your feet while doing so. Nights will be more difficult, some patients sleep with their heads facing the mattress, other choose to sleep sitting up.

The gas bubble will disappear on its own in 15 to 20 days, sometimes more or less depending on the type of gas used. During the re-absorption, your will see a large dark bubble in your inferior visual field as if you were looking at a fish tank. During the entire time that the bubble is in your eye, all airplane travel is forbidden.

After a week’s time, the healing process is complete; you can go back to a normal life and let the bubble position be a distant memory. However, you will still need to follow a few precautions during the first couple of weeks.
- First, don’t irritate your eye; be careful when you use shampoo and soap and do not use swimming pools.
- Second, avoid all sources of infection. Avoid catching a cold and avoid infected people. An ocular infection is a very serious complication that necessitates emergency treatment. If your eye is experiences redness or pain call your surgeon immediately.

After the bubble has disappeared, your vision will progressively improve during the following six months. If all goes well, and if the “bubble position” was well executed, within a month you will return to the level of vision that you had the before the operation, and it will no longer get worse. The visual improvement will take place in the following six months. So don’t plan to change your glasses prescription during the first six months.

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