MACULAR HOLE - Retina Vitreous Associates of Florida (2024)

FAQs

When is it too late to treat a macular hole? ›

WHEN IS IT TOO LATE TO OPERATE? The duration of a patient's symptoms is an important predictor of anatomic macular hole closure and visual improvement. Kelly and Wendel reported that visual outcomes were best for those with symptoms existing for less than 6 months.

“For certain patients, medicated drops may heal their macular hole by decreasing inflammation and increasing fluid absorption in the retina,” said ophthalmologist and retinal surgeon Dimitra Skondra, MD, PhD, senior author of the study.

Since macular hole surgery is never an emergency, it is sometimes worthwhile waiting a short time to see if a small macular hole will close on its own. When macular holes abort, or spontaneously close, the vision often returns all the way to normal over the course of about a year.

Ocriplasmin injection

If a macular hole is caused by vitreomacular traction, it may be possible to treat it with an injection of ocriplasmin, also called Jetrea, into the eye. The injection helps the vitreous jelly inside your eye to separate from the back of the eye and allows the macular hole to close.

There are 2 ways that your eye doctor can fix holes or tears in your retina: Laser surgery (photocoagulation) Freeze treatment (cryopexy)

Jayco*ck et al reviewed 55 cases of patients undergoing macular hole repair over a 2-year period and noted that hole closure rates were 94% among patients undergoing surgery within 1 year of symptom onset. The rate dropped sharply to 47% among those for whom surgical repair was delayed longer than a year.

These xanthophylls aid in eye health and have been shown to reduce the risk of several eye-related complications [9,10,11,12]. Vitamins A, C, and E are the most effective vitamins for reducing the risk of macular degeneration [13].

At an advanced stage, a macular hole can cause a black patch at the centre of your vision. Because of this, it may affect your ability to drive safely. The DVLA has a minimum required standard of vision for driving. Speak to your ophthalmologist for advice, based on how the condition is affecting you.

Patients having vitreo-retinal surgery for a macular hole will need to posture face down for 14 days; for other conditions this is only necessary for 5 days.

Most macular holes form because of changes in the eye that happen as you age. Some people with macular holes have mild symptoms and may not need treatment right away. But doctors may recommend surgery to protect your vision if a macular hole is getting bigger, getting worse, or causing serious vision problems.

How long do you have to be face down after macular hole surgery? ›

Facedown positioning for 3 days to 1 week after surgery for idiopathic macular hole repair remains the traditional standard of care. This is a significant source of morbidity for patients, however, as it is difficult and uncomfortable.

Following the introduction of vitrectomy by Kelly and Wendel [5], the closure rate increased to 58%. As surgical techniques and instrumentation have improved, the closure rate has increased to as high as 90% [10]. However, as with visual outcomes, surgical outcomes differ by the MH type.

If a macular hole is caused by vitreomacular traction, it may be possible to treat it with an injection of ocriplasmin, also called Jetrea, into the eye. The injection helps the vitreous jelly inside your eye to separate from the back of the eye and allows the macular hole to close.

With disruption, stress may be transmitted through the central fovea predisposing to the development of various disorders, including macular hole formation.

You must not fly or travel to high altitude on land while the gas bubble is still in your eye (up to 12 weeks after surgery). If you ignore this, the bubble may expand at altitude, causing very high pressure inside your eye. This will result in severe pain and permanent loss of vision.

If you do have a macular hole and you don't seek help, your central vision will probably get gradually worse. Relatively early treatment (within months) may give a better outcome in terms of improvement in vision.

There are four stages of a macular hole: small foveal detachments with a partial-thickness defect (stage 1), small full-thickness holes (stage 2), larger full-thickness holes without vitreous separation from the retina (stage 3), and larger full-thickness holes with vitreous separation (stage 4).

Spontaneous resolution of such holes was reported in a range from 2.7% to 8.6% of cases [15–17]. Some patients can be observed with so-called macular microholes, holes within 50–100 µm without VMA [18]. But usually holes progress and 34.4%–79% [19, 20] had progression in hole size from 2 to 6 years follow up.

Introduction. Stage 1 macular holes appear clinically as small central yellow spots that probably represents tissue swelling. ¹. Gass first described stage 1 macular holes as loss of the normal foveal contour; he believed the etiology was vitreomacular traction (VMT).