Macular Hole Surgery

A macular hole is almost always a spontaneous development that occurs predominantly in aging women. The development of a macular hole progresses through several stages, and with each progressive stage the vision may worsen. It has been postulated that shrinkage of the vitreous humor may produce traction on the fovea (central macula), thereby producing the hole itself. However, the cause of macular holes remains under investigation.

The diagnosis of macular holes in the early stages may be challenging or difficult, especially when there are other disorders of the macula, such as age related macular degeneration. Most eyecare practitioners would rely on both the patient's vision and the subtlest signs of the disorder, which early on may include only a faint yellow spot or ring in the macula. Dr. Anderson diagnsosises the macular holes based on the patient’s vision, retinal appearance and the addition of the Ocular Coherence Tomographer scans. Optical coherence tomography is a new, noninvasive, noncontact, imaging technology capable of producing cross-sectional images of the living human retina with extremely high resolution (approximately 15 microns). Of particular clinical importance at the present time is the early and accurate detection and staging of macular holes, often a severe form of vision loss and in the localization of fluid accumilation within the retina, such as can be found in central serous retinopathy or diabetic maculopathy. Fluorescein angiography may sometimes be helpful in making the diagnosis as well. This diagnostic procedure is extremely safe and entails the intravenous or oral administration of fluorescein dye, followed by retinal photography.

The likelihood of visual improvement with macular hole surgery is about 70%. However, about 90% of macular holes can be successfully closed with surgery. For patients who develop a macular hole, the risk of developing a macular hole in the opposite eye is about 10%.

Indications for Macular Hole Surgery

• Presence of macular hole, confirmed by examination
• Reduction of vision due to macular hole
• Decision for surgery may be influenced by vision and/or condition of opposite eye

Surgical Procedure
Dr. Anderson will referr you to a retinal specialist in the Denver, CO office. The repair of a macular hole begins with a vitrectomy procedure done in the surgeon’s surgical operating room. The second aspect of the procedure typically involves a membrane stripping (removal of a membrane on the macula). Finally, in most cases, a gas bubble is placed with the vitreous cavity to help keep the macular hole closed while the retina heals. Unfortunately, patients must maintain face down positioning for about one to two weeks in order to keep the gas bubble over the macular hole. An alternative to gas bubble injection is injection of silicone oil within the vitreous cavity at the conclusion of the surgery. Silicone oil placement does not require face down positioning after surgery, however, a second operation to remove the silicone is required, usually within a few months following the initial surgery.
The risks of macular hole surgery include bleeding, infection, retinal detachment, glaucoma, and progression of cataract.

After Your Macular Hole Surgery
After macular hole surgery, you will likely be required to remain in a face down position as much as possible for the first one to two weeks following surgery if your surgeon has injected a gas bubble into your eye. The gas bubble will help to hold the macular hole closed while it heals, but only as long as you remain in a face-down position, as this allows the gas bubble to rise and keep the hole closed.
If silicone is injected into the vitreous cavity of your eye, face-down positioning is not required. However, it is necessary to remove the silicone during a second operation, usually completed a few months later. Following macular hole surgery, you will likely be required to use antibiotic and anti-inflammatory eye drop medications for the first few weeks following surgery. Your retinal surgeon will prescribe a regimen of care and follow-up appointments, which you should follow carefully. After you have been determined stable, the retinal specialist will refer you back to Dr. Anderson’s care. Yearly dilated eye examinations with retinal scans performed with the Ocular Coherence Tomographer will be needed.

Village Optical: In town state-of-the-art eye care
Local: 970 223-0592 | Toll Free: 866 293-5219 | Fax: 970 377-1082
Email: info@villageopt.com
4103 Boardwalk Drive, Suite 100 | Fort Collins, CO 80525

Site Usage Conditions
Copyright © Village Optical and Dr. Kevin Anderson