Macula Hole Repair Surgery

“Honour your calling . Everybody has one. Trust your heart, and success will come to you” (by Oprah Winfrey).

I consider myself lucky to have gravitated to a specialty I don’t only find emotionally gratifying but that is also so dynamic . It keeps one on ones  toes and one has to read to keep up with modern medical and surgical treatment trends.

There is condition called macula hole which is more common in females of a mature age(seventies) in a ratio of  3.3 :1. Younger patients can have macula holes – these are almost always traumatic except in severe shortsightedness(myopia) where a retinal detachment may be associated with a macula hole.

How would know you have a macula hole?

Large macula holes are easy to spot because of a large dark spot in field of your vision (scotoma). Smaller macula holes can be difficult to notice if the vision in the fellow eye  is perfect. A simple screening test can be done in the comfort of your home is called an Asmler grid as shown below

 Look at the cross hairs using your reading glasses, asses each eye independently. Lines should be straight and meet perfectly in the center – if they don’t please book with your ophthalmologist

What if you decide not have macula hole surgery? Can I be blind ?

No, your central vision will not be restored but you will always have peripheral vision which can be used to navigate around. So you can’t recognise fine detail or read but you can walk around using your peripheral vision to avoid obstacles.

Can macula holes heal on their own ?

Yes very small ones can. Your ophthalmologist will advise if you fall in the category.

How are macula holes fixed ?

This is a surgical procedure. Jelly at the back of the eye is removed and a paper thin layer on the retinal surface is carefully  removed called the internal limiting membrane (ILM)

The eye is filled with gas which can last for up to three weeks . Your ophthalmologist can ask you to posture face down if you are able to or just from side to side but you can never lie on your back because gas needs to plug your hole like a band aid.

The limitations of gas is that you cannot travel to altitudes, either driving or flying. Gas expands and it’s not safe to fly. Blood supply to the eye will be disrupted and the eye can go  blind.

Patients who have surgery in different cities from where they live may have silicone oil inserted in the eye which works the same. Silicone oil needs to be surgically  removed from the eye at a later stage.

• 

• 

Are all macula holes fixed with a single operation?

Not always.

Some patients can experience non- closure with initial surgery and need a hole  plugged with bits of the internal limiting membrane. This layer acts as scaffolding facilitating surgical closure. Your ophthalmologist will best advise you on how to proceed.

Can macula hole affect  both eyes?

Yes. Jelly( vitreous) that’s very adherent to underlying retina can be a risk factor for bilateral macula holes

I hope you enjoyed this write up and it’s alleviated some of your concerns about macula hole repair surgery. If you have any concerns, please feel free to book an appointment at the surgery.