Mr David has advised you to have macular hole surgery. You may wish to discuss the information with a relative or carer. Before you have the operation, we will ask you to sign a consent form, so it is important that you understand the following information.
What is the macula?
The macula is the most sensitive part of the retina that is used for fine vision and reading.
What causes macular holes?
Unfortunately many diseases affecting the retina also affect the macula and can result in loss of vision. Macular holes are a relatively common cause of visual loss. The exact cause is still unknown, but macular holes are probably caused by the vitreous (the jelly-like substance inside the eye) pulling on the macula.
What symptoms will you notice?
Eyesight usually drops dramatically. Reading becomes difficult and many patients also complain of distortion of their vision.
What is the treatment?
The treatment involves surgery. Recent advances in the technology of micro-instruments and optical viewing systems now allow ophthalmic surgeons to perform surgery on the retina from within the eye. This has resulted in the successful treatment of complex eye problems, such as macular holes, which were previously untreatable.
More recently, macular holes detected early can be treated by an injection called Ocriplasmin into the eye.
What type of anaesthesia is used?
Mr David now performs the majority of his macular hole surgery as a day case under local anaesthetic. General anaesthetic is still available for anxious patients. If having a general anaesthetic you should not eat or drink for 6 hours before the procedure. If having a local then light food and drink is allowed up to 1 hour before the procedure.
Before the operation both Mr David and the anaesthetist will speak to you and examine you on the ward. You will then be given eye drops to enlarge your pupils. When you arrive in the anaesthetic room a needle will be placed in your hand or arm.
During your operation three needle-sized holes (0.64mm) are made in the white of the eye allowing removal of the vitreous jelly. This will allow Mr David to repair the macular hole with delicate intraocular instruments that are used to remove any scar tissue holding the macular hole open.
The vitreous jelly will be replaced by a gas bubble that will act as a support to hold the retina in position to help it to close.
Small stitches (that dissolve spontaneously) are usually placed in the eye and at the end of the operation we will put a pad or bandage over your eye to protect it and reduce swelling.
Following the operation we will usually ask you to keep your head in a face down position for a few days. This is called 'posturing' and aims to provide support from the gas bubble to seal the macular hole. You only need to posture for 50 minutes every hour during the day and can sleep in your normal position.
Mr. David will advise you on the posture you need to maintain and the duration of the same after you operation.
By following our instructions you will give your macula the best chance to be successfully treated. Your co-operation matters a great deal.
After the Operation
Most patients are able to leave hospital within a few hours of the procedure. If you have discomfort we suggest that you take a pain reliever, such as Paracetamol every 4-6 hours. It is normal to feel itching, sticky eyelids and mild discomfort for a while after macular hole surgery. It is common for your eye to water. Occasionally the area surrounding the eye can become bruised. Any discomfort should ease after 2-3 days. In most cases your eye will take about 6 weeks to heal. You will normally see Mr David in the clinic 2 weeks after your operation. Try to rest while your eye is healing.
We will give you eye drops to reduce any inflammation and to prevent infection. We will explain how and when you should use them. Please do not rub your eye.
Certain symptoms could mean that you need prompt treatment. Please contact the hospital immediately if you have any of the following symptoms:
A lot of pain.
Loss of vision
Increasing redness of the eye.
A shadow developing in the vision
When you have a gas bubble in your eye you must not travel by aeroplane or ascend to significant altitude by other means of transport and must warn your doctor you have a gas bubble in the eye should you need another operation of any kind.
The outcome of Macular hole surgery
Mr David's most recent audit has confirmed a surgical success rate of 95% closure of macular holes and associated improvement in visual symptoms and reading ability. Visual improvement also depends on the duration of the macular hole. On average, vision improves by 2 lines on the vision chart.
Risks of surgery
Macular hole surgery is not always successful. Every patient is different. Around 5% of patients may need more than one operation.
There is a risk of complications, either during or after the operation. Minor complications are common and in most cases we can treat them effectively. Very rarely some complications can result in blindness.
Possible complications during the operation:
Bleeding inside the eye
More holes in the retina
Dislocation of any intraocular lens
Possible complications after the operation:
Bruising / swelling of the eye or eyelids
High pressure inside the eye
Inflammation inside the eye
Allergy to the medication used
Infection in the eye (endophthalmitis). This is very rare, but can lead to serious loss of sight
Inflammation around any implants used
If the first operation is not successful Mr David will occasionally consider a repeat procedure, although this is not usually necessary.
Most patients undergoing macular hole surgery usually develop a cataract in the operated eye over the following 6 months. Cataract surgery is a much less invasive procedure and can be carried out as a day case under local anaesthetic. Occasionally Mr David may combine the vitrectomy operation with cataract surgery.
Please see below a video of Mr. David performing a Macular Hole surgery