At the 1-month postoperative visit, ophthalmoscopy revealed a microbubble in the macula of the left eye ( Figure 2). The patient was instructed to maintain 3 days of postoperative positioning, alternating between lying face down and on the left side. Surgery was performed with PPV, retinotomy, endodrainage, air fluid exchange, and 14% perfluoropropane (C 3F 8) gas infusion. Optical coherence tomography (OCT) performed prior to the repair of this newly found retinal detachment showed evidence of a pseudohole ( Figure 1). Dilated fundus examination revealed a nasal, macula-sparing, rhegmatogenous retinal detachment (RRD), macular pucker, and a pseudohole. On examination, visual acuity was 20/60 in the left eye. The patient’s past ocular history was notable for macula-involving rhegmatogenous retinal detachment following pars plana vitrectomy (PPV) several years prior to presentation. If you think you might have a macular hole, contact an ophthalmologist for an examination.A 67-year-old pseudophakic man presented to the Retina Group of Washington clinic with a complaint of a shadow in the peripheral vision of the left eye. You will be given a prescription for some light painkillers to be used for 3 days, and eye drops to be used for 4 weeks. You will be given an eye shield which should be worn while sleeping for the first week. It is common to experience mild irritation for a few days after the surgery. There is usually very little pain following the operation. Some types of general anaesthetic agents must be avoided (nitrous oxide or laughing gas) while there is a bubble in your eye. mountains) until the bubble is completely gone. You may not fly in an airplane or travel to high elevations (i.e. The maximum improvement will be noticed between 6 weeks and 9 months after the surgery, and vision may continue to improve as the retina remodels itself. You should not expect a significant improvement in your vision until at least 6 weeks after the surgery. As the bubble reabsorbs you will gradually see more and more. Vision will be markedly reduced after the surgery as you cannot see well through the bubble. As the bubble is reabsorbed, the vitreous cavity refills with a fluid that is naturally produced in the eye. Gas placed within the eye will be gradually reabsorbed by the eye during a 2-8 week period following surgery. This ensures that the gas bubble with stay in contact against the macular hole. In order to maximize the effect of the bubble, you may be requested to maintain face down (prone) positioning or positioning on your side for a period of time after the surgery. The characteristics of the macular hole will determine which type of gas tamponade is required. There are three types of gas, lasting between 2 and 8 weeks. The surface tension of the gas bubble acts to aid in closure of the macular hole. The vitreous gel is replaced with a slowly dissolving inert gas at the end of your surgery. The hole cannot be manually plugged or closed the surgery creates the optimal environment for the hole to close itself. This, together with the placement of a gas bubble, creates an optimal environment for the cells to migrate across and for the hole close. A surgical procedure is performed which involves removing the vitreous gel and internal limiting membrane (the innermost layer of the retina) to relieve the traction on the macula. The vitreous separates from the retina and is more adherent at the macula.Ī small or partial-thickness macular hole may close spontaneously without any intervention, whereas a large or full-thickness macular hole usually requires surgery. This is due to disruption of the normal physiologic arrangement of the photoreceptors (light sensing cells) in the centre of the macula, and due to collection of fluid under the retina in this area. Visual acuity decreases markedly depending on the size of the hole. There is no actual loss of tissue in the hole. When it does this, it can pull on the centre of the macula and create a full-thickness defect. It eventually pulls itself loose from the retina, in a process called a “posterior vitreous separation”. As you age, the vitreous undergoes changes and “shrinks”. The vitreous is a gel-like substance which fills the central cavity of the eye. This hole is as a result of traction (pulling) of the vitreous on the retina. It is equivalent to a hole in the centre of the film in a camera. A macular hole is a full thickness defect in this important location of the retina. The macula is the centre of the retina where the highest visual acuity is obtained.
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