If you think of your eye as a camera,the retina is like the photographic film.It is a very thin layer of tissue,which is sensitive to the image focused on it,and sends the information to the brain.
At the very centre of the retina is the macula.This is a very special area of the retina,which we use for reading and recognising complex shapes.Sometimes,a hole forms at the macula.If this happens,the macula cannot work normally.This affects your vision,particularly for reading and other visually demanding tasks.However,it does not cause total blindness.
The only way to treat a macular hole is an operation.Eye drops or glasses are ineffective.
Some patients decide not to have an operation and accept the poor central vision in the affected eye.This is reasonable, especially if the vision in the other eye is not affected. There is no ”right” or “wrong” decision as every person has different needs and priorities.
You should discuss your reasons for wanting to proceed with an operation, or for deciding not to have surgery, with your consultant.
If you decide to have a local anaesthetic, you will be awake during the operation. You will not be able to see what is happening, but you might be aware of a bright light. Before the operation, we will give you eye drops to enlarge your pupil. After this,we will give you an anaesthetic to numb your eye. This involves injecting local anaesthetic solution into the area around your eye.
During the operation, we will ask you to lie as flat as possible and keep your head still.
The operation normally takes about an hour,but might sometimes take a little longer.
If you decide to have a general anaesthetic, we will ask you not to eat or drink for six hours before your surgery, although you may drink sips of water up to two hours before the operation. Prior to surgery, an anaesthetist will speak to you and examine you on the ward. The nursing staff will give you eye drops to enlarge your pupil. When you arrive in the theatre’s anaesthetic room, the anaesthetist will give you an injection in your hand or arm. You will then stay asleep for the whole operation. The anaesthetist will monitor your heart rate,breathing,blood oxygen and blood pressure while you are under the anaesthetic. You might feel tired and sleepy for about six to 12 hours after the operation.
The operation will be performed by an experienced surgeon.A more junior surgeon might perform some, or all, of your operation under the supervision of an experienced surgeon.
You will need an operation called a “vitrectomy” to repair the macular hole.This involves making tiny cuts in the eye and removing the vitreous from inside.Then your eye is filled with a bubble of special gas.It is replaced by the eye’s own aqueous fluid.While the eye is full of gas, it cannot see clearly.
We usually put small stitches in the eye.These dissolve naturally over about four to six weeks.At the end of the operation,we usually put a pad and shield over your eye to protect it.These will be removed the morning after your surgery.
Following the surgery,your surgeon may require you to “Posture” ,which means lying or sitting in a position that keep your face down for 10days.This position allows the gas bubble to press against the macula and seal the hole.Your surgeon will advise you if it is necessary for you to posture after your surgery.
The eye will feel uncomfortable,gritty,and itchy.It might appear red or bruised.This is normal for seven-14 days.
Take paracetamol for pain relief every four to six hours.
The eye takes two to six weeks to heal, but your vision might continue to improve for several months.
Your vision will be very poor with the gas in your eye.
As the gas disperses ,you will begin to see a line,which wobbles in your vision,like a spirit level.you will be able to see above the line,but the vision will be fuzzy underneath.This line will continue to ease downwards until only a tiny bubble is left and, finally, it too will disappear.
You may need to return for a check up the day after your surgery.
We will give you eye drops to reduce any inflammation,to rest your eye and to prevent infection.we will explain how and when you should use them .Please don’t rub your eye.
The nurses will explain your follow-up appointments to you on the ward.You will also be seen in 10-14 days in the outpatient clinic.
While a certain amount of discomfort is normal after the surgery,you should contact the hospital immediately if you have any of the following symptoms:
A lot of pain
Loss of Vision
Increasing redness of the eye
We use two types of gases:
-C3F8 Which is long acting and can stay in the eye for up to 10 weeks,
-SF6 Which can stay in the eye up to two to three weeks.
You must not fly while there is gas in your eye.
You must inform the anaesthetist if you need a general anaesthetic before the gas has completely gone from your eye,as he/she cannot use nitrous oxide gas in your anaesthetic.
Posturing is the hardest part of the recovery following your surgery,but the most important.Your surgeon will advise you if it is necessary for you to do this.
We may ask you to posture face down.This position allows the gas bubble to float up against the macula providing support while the macular hole heals-a bit like a splint on a broken bone.You must maintain a face down position for 10 days and 10 nights following the surgery to keep the gas bubble in contact with the macula.The success of your operation depends on how well this positioning is maintained.
During the day:
Your face and eyes must be looking down as though you are reading a book positioned in your lap.During the day, try sitting in a comfortable chair,leaning over a table and resting your forehead on your arms or a pillow.If you have good vision in your other eye,it is possible to read a book positioned in your lap or watch TV by placing the TV on the floor by your feet and putting a mirror in front of it.
At night time:
At night time,you will have to sleep on your stomach.Some patients have moved the mattress down the bed to allow a space at the top and have placed pillows in a ‘ V ‘ Position in this space,so that you can breathe while still maintaining the face down position.
Do not sleep on your back.
Some patients put rolled up blankets and pillows on each side to prevent them from rolling over whilst they are sleeping.
The positioning must be maintained night and day.
This positioning must be maintained for 10 days.
You must carry out the posturing for 50 minutes out of every hour.
Please a void sitting or lying in bed for long periods of time without moving your legs.It is important for you to avoid prolonged immobility.When you are sitting, try moving your anlkles around and going up and down on your tiptoes.During your 10-minute rest periods,you are able to walk around.
Do not fly in a plane while there is gas in your eye.When the gas has gone,you can fly again.
If you require a general anaesthetic for any operation while the gas is still present in your eye,please advise the anaesthetist not to use nitrous oxide gas in the anaesthetic and contact your Ophthalmologist(eye doctor).
We know that posturing is very difficult,but it is necessary
Most people find the following helpful:
Provided you have good vision in the other eye,you can read
Watch TV by placing the TV on the floor by your feet and putting a mirror in front of it. A portable DVD player may be useful,as you can open the screen so that it lies flat.
If you have good vision in the other eye, you can use a portable computer, with a screen that can lie flat.
Buy ready meals if you live alone
Ask friends to visit to break up the day.
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