Thursday, October 27, 2011
Treatment for Macular Holes
Macular holes were once considered an untreatable problem; however, because of advances in retinal surgery, many patients can be helped. It is possible for anyone to develop a macular hole, but they are most common among women about 60-70 years of age. Macular holes may occur for a variety of reasons, but are usually a result of traction from the vitreous gel on the macula. Since the macula is responsible for central vision, this problem causes severe and often complete loss of central vision.
Fortunately, we’ve come to understand this problem better than ever before and can even restore vision in many cases with surgery. The extent of the patient’s recovery is dependent on several factors such as the severity of the hole, time since onset, and other variables. Sometimes the hole spontaneously resolves, although it is much more common to require surgery.
The operation is performed with local anesthesia under a microscope. During the procedure, the doctor injects a gas bubble inside the eye. The purpose of the gas bubble is to place gentle pressure on the retina and help seal the hole.
The biggest challenge of macular hole repair is to maintain the proper head position afterward. Since gas rises, the patient must be able to keep his or her head down so the bubble floats up and presses on the back of the eye. This is very critical for approximately two weeks following the surgery. There are many creative ways to stay in the correct position and remain comfortable. The body slowly absorbs the gas bubble over approximately three months. In some cases, the eye is filled with silicone oil instead of gas. This is easier for the patient because no special positioning is necessary; however, the oil must be removed with a second operation several months later.
With the surgical treatments available today, we are able to restore partial vision in 70-90% of our patients. Most patients find that their vision improves approximately two lines better on the eye chart.
As retinal surgeons, we are encouraged by the advances made in the field of macular surgery. New treatments are being developed all the time as we continue to learn about this incredibly complex sensory tissue.
Posted by Venkataramanan Ramasethu