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                                                                                       Vitrectomy and Macular Hole Procedures 

What a macular hole and how are they formed?

A macular hole is a small break in the macula which is the part of the retina responsible for central vision. Most macular holes or macular puckers require surgical repair. They are caused by the vitreous (the jelly-like material in the eye) shrinking and separating from the retina and, over time, pulling on the macula, forming a macular hole. Apart from avoiding trauma, nothing can be done to avoid a macular hole and they mostly occur in people over 60.

How do you know you have a macular hole?

They can occur gradually or suddenly. Early signs are slight distortions or blurriness in central vision. A blind spot can develop as the macular hole gets larger. Covering one eye to test the other eye is the simplest way of detecting a change to central vision. If there is a problem consult your ophthalmologist. The ophthalmologist may ask you to draw an outline the distortion of your central vision on an Amsler Grid Chart and confirm it with an OTC scan of your retina. The scan takes a picture of your retina, which will show the hole in the macula.

 How is the macular hole treated?

Surgeons perform vitrectomy surgery to remove the eye’s natural fluid( the vitreous jelly) from the eye, peeling the jelly away from the retina and relieving the traction on the macular hole. The space in the eye is then filled with a gas bubble (replacing the vitreous). The gas then acts to hold the retina in place. The procedure is normally performed under local anaesthesia and can be done as day surgery or with an overnight stay in hospital. There is usually very little post operative pain.     

It is important for the gas bubble to press against the macular hole to close it. The gas bubble rises so the patient needs to position the head face-down to make sure that the pressure is at the back of the eye where the macular hole is located. Over time the gas is gradually reabsorbed by the eye and replaced with the eye’s natural vitreous fluid. 

With the eye filled with gas vision is very poor… but as the gas bubble gets smaller, breaks up in to smaller bubbles (which look like black dots) and then disappears  sight will start to return to normal (if the macular hole is closed). Depending on the type of gas instilled, the bubble usually lasts from two to eight weeks.

It’s important not fly in a plane or travel at high altitude while there is a gas bubble in their eye as the gas will expand at higher altitudes which can cause pain, high eye pressure, and permanent visual loss.

A vitrectomy is mostly used for treatment of Macular Holes and Macular Pucker but they can also be used in patients who have retinal detachment, age related macular degeneration and sub-macular haemorrhages.

Successful closure of the hole can occur in up to ninety percent of cases, but the improvement in vision is more variable. Visual recovery usually occurs slowly and can continue for up to three to six months after surgery. Most patients experience a noticeable degree of visual improvement.

The importance of posturing

Positioning face down as much as possible is critical to the success of the surgery. This process is called ‘posturing’. When posturing the gas bubble rises and exerts pressure in the back of the eye where the hole is located which helps to close and repair the macular hole  The period of posture is usually for 7 to 10 days, although some ophthalmologists are now recommending shorter periods. (different procedures may also require different posturing periods).

Correct posturing also decreases the possibility of cataract formation and raised intraocular pressure.

Always follow your advise of your ophthalmologist on how long you need to posture. Most patients are required to posture for 50 minutes every hour in the day and when sleeping (using the break  to eat, bathe, insert eye drops and for bathroom needs).

Staying face down for a long time can be difficult and may be made more difficult if someone has other problems such as arthritis. It is therefore important to discuss any other medical problems that may affect your ability to posture with your ophthalmologist.

RetinaRecovery posturing equipment will assist you greatly in achieving correct posturing. 

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