If
you’ve been diagnosed with a macular hole,
it is important to understand how it is caused,
and how surgical treatment can repair the hole.
What causes a macular hole?
The eye is filled with a gel called vitreous. As a natural part of the aging
process, the vitreous gel shrinks away from the retina which lines the back
of the eye. The center of the retina is called the macula. The macula is
involved in fine visual tacks like reading and is also one of the thinnest
parts of the retina. As the vitreous separates from the retina it may remain
stuck to the macula eventually resulting in a macular hole. Visual acuity
is decreased by the macular hole and tasks such as reading become difficult.
How is a macular hole diagnosed?
An ophthalmologist or retinal specialist can diagnose macular hole by dilating
the pupil and examining at the retina. Sometimes, specialized tests called
fluorescein angiography or optical coherence tomography (OCT) will be performed
to confirm the diagnosis. These tests are commonly performed in a retina
specialist’s office.
Can a macular hole be fixed?
Macular holes can be repaired and vision improved by performing an operation
called a vitrectomy. This operation is typically performed under local anesthesia
with some sedation so that the patient does not have to be completely asleep.
During surgery the vitreous is removed, and an air bubble is placed in the
eye. After surgery the patient must keep his of her face down for at least
one week to allow the air bubble to push on the macular hole and close it.
Face down positioning is critical to the success of the surgery.
What should I expect the day of surgery?
All preoperative testing, including a physical exam, will be arranged and conducted
before the day of surgery. You will be told the time to arrive at the hospital
on the day of surgery. The surgery takes about one hou,r but plan to spend
most of the day at the hospital.
What happens to the air bubble?
With time, the air bubble is slowly absorbed by the body, shrinking in size.
As this happens, it will look like a black line which, moves lower in your
field of vision. As it gets smaller, it may seem like a black circle and
occasionally it may break into smaller bubbles before it goes away completely.
Are there any activity restrictions during
this period?
While the bubble is in the eye, air travel is not permitted. (The change in
pressure can cause the bubble to expand too much.) Also, you will be given
a special medical alert bracelet to wear until the bubble is gone. The bracelet
would alert medical personnel if your were in an accident that you have an
air bubble in your eye that would require adjustments in the way general anesthesia
would be given to you if you needed surgery.
There are no strict activity limitations, but
many activities are not possible while maintaining
face-down positioning.
• Watching television is allowed if a
small TV is placed on its back and kept near
your feet.
A special head rest is also available to rent from
a medical supplier which can aid in keeping your
head down. It also has a mirror that allows a TV
placed in front of the patient to be viewed. Patients
can ask the nurse for a brochure.
• Short walks are permitted, as long
as you are able to maintain correct head positioning.
(It is helpful to walk with someone to help guide
you.)
• Books on tape are a good way to pass
the time. These are available at most libraries.
Reading
is not allowed.
• A back or neck massage is often helpful
in relieving discomfort caused by positioning.
What are my chances that the hole will
close?
This depends upon several factors, including the size of the hole and the amount
of time the hole was present before surgery. If the hole has been present for
less than one year, the chance for hole closure is greater than 90%.
What will happen if I look up by mistake?
If you lift your head momentarily to stretch your neck, or look up for a very
short period of time, it will not cause damage. However, for best results,
you goal should be correct head positioning 24 hours a day.
Will I need any special medications after
surgery?
Eye drops will be prescribed the day after surgery. The typical drops are:
ATROPINE -Used to keep the pupil dilated—helpful while the eye is healing.
ZYMAR -An antibiotic drop used to protect against infection.
PRED FORTE -A steroid used to decrease inflammation.
You may need additional drops or ointments depending on you individual case.
How can I help keep my head in the correct
position?
•Plan ahead.
•Practice positioning before surgery—perform typical daily activities
(cooking, eating, showering, toileting, etc.) in a face-down position in order
to make any adjustments in placement of needed items.
•Ask the nurse about renting a special head rest that is available.
Eating.
You may prepare your own meals, but make sure all items needed are on the kitchen
counter or below, not up in the cupboards. Keep refrigerated items on the
lower shelves. Prepare softer foods that are easy to chew and swallow in
a face-down position!
Drinking.
Always use a straw. If you take large, difficult to swallow oral medications,
break them into smaller pieces and mix in a soft food like apple sauce or
mashed potatoes.
Personal Hygiene.
Put all toiletries on the counter so you can find then easily. If your toilet
paper is in an inconvenient place, put in on the floor. If possible, men
should use an electric razor to shave. A mirror placed flat on the bathroom
counter is also helpful.
Activity Restrictions.
You do not have to remain in one place to the entire post-op period, but do
have to remember that everywhere you go and everything you do must be in
a face-down position—lying, sitting, standing or walking.
Correct head positioning:
Please feel free to call the office and speak
with a nurse with any further questions or concerns. |
