The Dunedin Hospital, Reading has worked closely with Mr Vaughan Tanner, Consultant Ophthalmic Surgeon, to develop a retinal surgical service, including Macular Hole Surgery, using the latest advances in instrumentation and techniques. The macula is a highly sensitive area of the retina, in the eye, that is used for fine vision and reading. Symptoms of macular hole development include sudden drop in central vision making reading difficult and frequently distortion of straight lines and text. Mr A.N. El-Amir also performs Macular Hole Surgery at Spire Dunedin Hospital.
Treatment of Macular Holes
The treatment of Macular Holes involves surgery. Recent advances in the technology of micro-instruments and optical viewing systems now allow consultants to perform surgery on the retina from within the eye.
This has resulted in the successful treatment of complex eye problems, such as macular holes, which were previously untreatable.
Consultants at Dunedin Hospital now perform the majority of his macular hole surgery as a day case under local anaesthetic, while general anaesthetic is still available for nervous patients. If a patient is having general anaesthetic you should not eat or drink for 6 hours before the procedure. If having a local then light food and drink is allowed up to 1 hour before the procedure.
Before the operation both the consultant and the anaesthetist will speak to you and examine you on the ward. You will then be given eye drops to enlarge your pupils.
The Macular Hole Surgery
During your operation three needle-sized holes are made in the white of the eye allowing removal of the vitreous jelly. This will allow Mr Tanner or Mr El-Amir to repair the macular hole with delicate intraocular instruments which are used to remove any scar tissue holding the macular open.
The vitreous jelly will be replaced by a gas that will act as a support to hold the retina in position to help it heal. Your normal body fluids will replace the gas naturally over 3-4 weeks.
Quite often consultants will remove mild cataracts as part of the same procedure.
Small stitches are usually placed in the eye and at the end of the operation we will put a pad or bandage over your eye to protect it and reduce swelling.
Following the operation we will usually ask you to keep your head in a face down position for 5 days. This is called 'posturing' and aims to provide support from the gas bubble to seal the macular hole. Posturing cushions will be provided and you should ensure that someone is at home to help you for the first 5 days. You only need to posture for 50 minutes every hour during the day and can sleep in your normal position.
(Further information on posturing will be provided by the consultant after your operation, and can be found below.)
Information sheet on posturing after your operation.
OCT of normal macular
OCT of stage 4 macular (vision 6/60)
OCT of repaired macular hole (vision 6/6)
After the operation
Most patients are able to leave hospital within a few hours of the procedure. If you have discomfort we suggest that you take a pain reliever, such as Paracetamol every 4-6 hours. It is normal to feel itching, sticky eyelids and mild discomfort for a while after macular hole surgery and it common for your eye to water, while occasionally the area surrounding the eye can become bruised. Most discomfort should ease after 2-3 days, while in most cases your eye will take about 6 weeks to heal. You will normally see the consultant in the clinic 2 weeks after your operation. Try to rest while your eye is healing.
Eyedrops will be given to help reduce any inflammation and to help prevent infection.
(Further information on your eyedrops, and how to administer them will be given to you by your consultant, and can be found below.)
Information on eyedrop administration.
Certain symptoms could mean that you need prompy treatment. Please contact the hospital immediately if you have any of the following symptoms:
- a lot of pain
- a loss of vision
- increasing redness in the eye
- a shadow developing in the vision
When you have a gas bubble in your eye you must not travel by aeroplane or ascend to significant altitude by other means of transport and must warn your doctor you have a gas bubble in your eye should you need another operation of any kind.
The benefits of Macular Hole Surgery
Mr Tanner's most recent audit has confirmed a surgical success rate of 96% closure of macular holes and associated improvement in visual symptoms and reading ability. This data has been presented at national meetings and conferences. Mr Tanner has never had a case of serious intraocular infection following macular hole surgery.
The risks of Macular Hole Surgery
Macular hole surgery is not always successful. Every patient is different. Around 5% of patients may need more than one operation.
Some possible complications
There is a risk of complications, either during or after the operation. Minor complications are common and in most cases we can treat them effectively. Very rarely some complications can result in blindness.
Possible complications during the operation:
- bleeding inside the eye
- more holes in the retina
- dislocation of any intraocular lens
Possible complications after the operation:
- bruising / swelling of the eye or eyelids
- high pressure inside the eye
- inflammation inside the eye
- double vision
- allergy to the medication used
- infection in the eye (endophthalmitis). This is very rare, but can lead to serious loss of sight
- inflammation around the implants used
- retinal detachment
If the first procedure is not successful a repeat procedure is often considered, although this is not usually necessary.
Most patients undergoing macular hole surgery usually develop a cataract in the operated eye over the following 6 months. Cataract surgery is a much less invasive procedure and can be carried out as a day case under local anaesthetic.