Macular Hole

I am going on 5 weeks post op.  Had the unfortunate complication of a corneal abrasion after surgery.  I am told this is not uncommon.  Can be due to prep in surgery, and also from extremely dried eyes from surgery.  Abrasion is 95% healed, it has taken 4 weeks to heal- a 3mmx1mm abrasion.  Also, I cannot see very well in my operated eye, even with corrective lenses.  Everything is foggy and blurry, and blank spot is still in the middle although the hole is closed.  I am hoping that my vision will improve.

I was diagnosed with a Macular Hole 15 years' ago. The operation had only been available for 2 years at that time, otherwise nothing could be done to prevent further deterioration. I was 65 years old then and my operation was considered to be a success. I had to posture for 3 weeks. As I lived alone I actually hired equipment which was a massage chair. I had to pay £225 for the hire. The equipment was delivered to my door and taken away when finished with. I do not regret one penny as I was determined to follow all the instructions correctly to render the operation a success.

I did not develop the promised cataract until about 8 years later and while I was on the hospital waiting list for the cataract I developed a detached retina. Both these are listed as possible side effects due to the operation, but you would expect to take them soon after the operation and not 8 years later. However, upon the discovery of the detached retina I was admitted the very next morning for surgery (yes that is how serious a detached retina is considerd or you could go completely blind in that eye if left for even 2 weeks i.e according to the operating surgeon.). While operating on the detached retina they also removed the cataract "(two for the price of one" said the surgeon). This time my posturing was for 2 weeks and I had to sit up straight which was a big improvement on my macular hole posturing.

Here I am today almost 80 years of age and the eye with the macular hole has only a slight distortion (not perfect as previous to the operation). and my other eye has perfect sight. I go every year to my local university department's eye clinic to get tested as (sorry) don't really trust a lot of high street opticians.  I now keep hearing of such posturing times which amazes me. One woman I know was at the hairdressers just under a week on after her macular hole operation, albeit she had to use a washbasin which tilted her head backwards!!. I was told not even to lift my head up. Trust this helps anyone with concerns.

I've just a macular hole surgery combined with IOL replacement (to prevent cataract development). Statistically I am too young for this problem with my 35y but I have myopia too which might have contributed to this problem.

Staying with the face down isn't the greatest fun but my first impressions are mixed- I was expecting some pain in my operated eye but it doesn't really hurt and despite the gas bubble I am able to see some foggy picture.

However, the neck is killing me and I only can imagine how agonising it must be in more advanced age to remain for long period in such uncomfortable position. Therefore my advice - if you have this surgery, rent, borrow or even buy a massage bed with attachable head support- it will make your life and your night sleep so much easier!!! Firstly it will keep your body leveled in more natural and comfortable position, support your head, allow you to breathe and you can even read or browse the Internet peeking through the head support hole. I also bought a massage chair with the head support which helps me to be able to sit during the day. Although it seems to week or two only, but help yourself with these devices and it will alleviate the physical stress a lot.

Now I am praying for a good outcome and to be able to read with the affected eye again as my vision rapidly went from 0.8 when it was first diagnosed to 0.2 prior to the surgery few months after.

Good luck to all of you and take care of your lovely eyes!!!

I just re-read through all of the comments on this discussion.  It is so good to be able to read through other experiences, as this is not a really common thing.  I found out that the problem i am having in my right (good) eye is a "floater".  They tell me it will always be with me, so I have affectionaly called him "freddie".  Anyway, now I have developed the long promised cataract in my operated eye.  I am nervous about this procedure as well.  The thought of someone working on my eye while I am awake is unsettling to say the least.  Coupled with the thought of how well I will be able to see when this is done - I am anxious.  I understand that it needs to be done, my eye sight has deteriorated from 20/60 the beginning of december to 20/200 last week.  The surgery is scheduled for Jan. 26 for removal of the cataract  - i pray for strength to complete the journey with this macular hole / cataract and hope that my vision will be fine when it is all over.  Once again, thank you to all of you who have responded - I appreciate you sharing your experiences, and words of encouragement.

I had my cataract surgery on Thursday Jan. 26.  The next morning my eye was reading 20/60 without my glasses and 20/30 with my glasses.  She told me that once the healing process is complete the eye will read slightly better or slightly worse - everyone heals differently.  I have a small flicker in the left portion of my left eye.  I am hoping that this will go away once I am completely healed.  I still have the blurry in the eye from the macular hole.  But, I am very happy that the surgery portions of this ordeal are over.

 

I am one of the unfortunate people to have a macular hole in both eyes. Two years ago I was diagnosed with stage 4 macular hole in my left eye. I received a bad advice and left the whole there and depended upon my right eye for vision. The left eye was quite distorted and impossible to read with.

In December of this year, I developed a stage one macular hole in my right eye. I went to Columbia-Presbyterian to see Dr S Chang. Per Internet review, Dr. Chang is the best in the country for macular surgery. I had great success with the vitrectomy and installation of gas bubble in that eye.

Dr. Chang said average time face down would be five days. Unfortunately I did not respond that quickly. I was facedown for 15 days. It was difficult, but when it's over it's over! I am now seeing 20/40 from that Eye without glasses. Corrected vision should be 20/20.

Dr Chang advised me to attempt to correct the left I. His theory is I have issues with both eyes and should keep both eyes at maximum health. Unfortunately I am not having the same success with my left I. I attribute this to the fact that I left it for too long. Dr. Chang is still not giving up on me. It is a difficult process but my eyesight is worth it. My vision prior to correction in my left eye is 20/125. Two procedures so far; I have not had success. I will be seeing him on Wednesday and make the determination on how to follow up with my left eye. My advice to you is find a good surgeon and take care of this problem as soon as possible.

I came across this page as I was researching Macular Holes & hope I can get some help & reassurance before my operation!

On 17th May I went for my usual yearly eye test (I'd also had my annual diabetic screening eye test a week before - type 2, controlling it so far with diet & exercise), both times I mentioned distorted & pinched vision in my left eye. Nothing was taken further at the diabetic screening, however luckily when I had my eye test, the Optometrist diagnosed a possible Macular Hole. She felt it needed urgent treatment & tried to phone the hospital to get me an appointment. No one was picking up, so she gave me letter to take to my doctor & ask them to contact the hospital ASAP. She also wrote on the envelope 'Please make an appt. within 1 week'.

I finally got an appt. for yesterday, 13th June, & her diagnosis was correct, I have a Macular Hole in my left eye. (My age is 73)

In the 4 weeks waiting for the appt. I've scared myself silly reading about the operation, the 'posturing', possible risks etc.

Yesterday the consultant recommended an operation & said as I had a cataract forming, they would also remove that at the same time. He said nowadays they recommend keeping your head downwards for between 3 & 5 days, for 50 mins each hour, with 10 mins for toilet breaks etc.

Now my questions if you can help please!

1)What's the average length of time people had to wait for their operation (the consultant said the sooner it's done, the more chance of success)

2)Has the 'posturing' really come down to 3-5 days, as lots of people on here seem to have to do it for much longer, or could it be because my cataract will be removed at the same time?

3)How painful is the actual operation & post op? I'm such a coward, with a low pain threshold, & already stressing out! (Can't believe I gave birth to 3 children!)

4)In view of my previous question, should I opt for local or general anethestic? The consultant said most people opted for local, however the nurse who then did all my pre-op details, arranged ECG/blood tests etc, said if I was really anxious I may be best having a general one.

I realise you recover more quickly from the actual operation with a local anethestic, but will I be able to keep perfectly still for between 60/90 mins!

I'm also worrying about having a general anesthetic, as I know there's more risks involved, & worry I won't wake up!

5) Has everyone who had the operation been glad they had it done, & has their vision improved significantly. (At the moment I can hardly read the second line of the eye chart, with my left eye)

Finally - we have a couple of (UK) family hols booked within the next 6 weeks, if I get an appt.for a couple of weeks before the holiday should I go ahead, or defer it till we come back?? I've told the hospital my holiday dates.

Sorry for such a long post, & thanks for your patience in reading to the end!

Hi,  I had vitrectomy, membrane peel and Cataract operation in August 2016 on my right eye.  The macular hole was closed but has left me with some scarrng which affects the central vision.  I have therefore been relying on my left eye for reading and driving.  In March 2017, after finding my vision deteriorating again, I was diagnosed with a macular hole in the left eye.  I have had repeated procedure on the left eye but the hole has not closed and my vision seems worse than before the operation.  I understand that the vitrectomy can be repeated which I think is my only option.  I am currently unable to work effitiently or drive legally.  I am a fit and healthy 66 year old and not wanting to retire yet.I am devastated that this has affected my way of life. Please excuse any errors in my typing but vision is not good and I do not see a spell check to help me.

I have just found this interesting thread. On Monday I had my second macular hole surgery in a private eye hospital in Bangkok where I live. I had the first surgery in the other eye with the same surgeon 20 months ago.  In both cases I had cataract surgery done at the same time, or rather just before the MH procedure. The gas tamponade will inevitably cause a cataract in due course and it is easier for the surgeon to perform MH surgery without the natural lens in place.  So many surgeons perform cataract surgery simultaneously in patients over 50, who already have the beginnings of cataract, as I did in both eyes, rather than make the MH procedure more difficult for themselves and make their patients go through the anxiety of getting full blown cataracts and having to have a second surgery within a couple of years.  However, it seems that with some exceptions, for whatever reason, the latter is standard British NHS policy. Perhaps they hope that enough patients will simply pass away without coming back for the cataract surgery.

My first MH was relatively small at about 200 microns.  I was asked to do 5 days posturing and found the hole had closed when I went back to the hospital for OCT scans 8 days after the procedure.  Although smaller in circumference the hole was quite deep and the gap in the retina, probably filled with fluid, remained behind the closed hole. The surgeon told me he was hopeful that this would drain itself and fill in but thought it might take about two years, since it was quite deep.  In fact it only took about 6 months to fill out and my vision returned to around what it had been about a year before the hole went full thickness, although I have a very small blank patch in my central vision caused by the scar on my macular where the hole healed   However, 10 months after the operation, I realised that my vision was starting to cloud over and when it got to the point I could no longer read road signs i went back to my surgeon  Fortunately he had an immediate answer and remedy.  The rear portion of the natural ocular lens capsule into which the artificial lens or had been inserted during the cataract surgery had been clouded over by the gas, just as the natural lens would have been, had it been left in place. A 5 minute procedure with a Yager laser cut a hole in the rear capsule solving the problem completely.  My vision worsened for a couple of hours and then all of a sudden snapped back into place. This is called posterior capsule opacification and is a common side effect of gas tamponades.

My second MH procedure was performed on an impending hole that the surgeon said was 80-90% of the way to becoming full thickness with only a negligible chance remainng it would resolve by itself.  Since it was already symtomatic, causing some distortion in my central vision, he suggested going ahead and operating, as he believed he could achieve a better result by not waiting for the hole to go all the way through. The is a risk that the epiretinal peeling can induce a full thickness hole but he said he saw no evidence that happened in the procedure.  Hopefully I will avoid further loss of vision from the scar left by a healed hole, although I don't expect that the distortion I have already from the hole behind the surface of the macular will improve much or at all.  At least it should not get worse.  I have been asked to do 3 days face down this time but will probably do 5 to be more sure. Even though the gas might not be needed to close a hole it might help to drain fluid from the gap behind the macular surface.   In the event the surgery did induce a full thickness hole, the gas should heal it without the need for further intervention.

Re face down posturing, my surgeon admits that it might not be necessary at all but since it is not certain he continues to recommend as an insurance policy.  If the eye is injected 95% full of gas, the bubble will be against the macular in virtually all positions that the patient is in except lying on his back.  Most holes close within 24 hours or at least within 2 or 3 days.  Therefore, during the critical period the hole will always be large enough to do its job in nearly position, as long as the surgeon fills up 90-95% of the eye with gas.  Many surgeons, particularly in the US now don't advice face down posturing at all but just ask the patient to avoid lying on his back.  Recognising that sleeping face down is torturous for many patients, and may be of limited use anyway, my surgeon, along with many others,  advises sleeping on the side opposite the operated eye, i.e. sleep on your right side if your left eye was operated on. It is a reasonable guess that face down posturing will ultimately not be used at all but, meanwhile, most surgeons are reluctant to part company with the past.

Re gas. The most common gas used today is SF6 which stays in the eye for 2 weeks.  Formerly Octoflouropropopane was commonly used which stays in the eye for 8 weeks.  Today the latter is normally only used for difficult cases, such as large holes or holes that failed to close in the first surgery, which might benefit from a longer healing time with the gas tamponade.

Re risk of occurrence of MH in the fellow eye.  This is usually stated as 10% which is probably accurate overall.  However, where traction is present in the fellow eye, i.e. the vitreous is attached to the macular and tugging on it, it seems more realistic to tell the patient that the risk of MH in the second eye is around 40%. That means that if you have no traction in the other eye, its risk is significantly less than 10%, since traction, as the vitreous dries out with age, is most likely what causes MH.

Re Age Related Macular Degeneration.  There is no known connection between this and MH.  However, the entire population including MH patients is at risk of getting AMD, if they live long enough.  A competent ophthalmic surgeon should easily be able to tell the difference between AMD and MH.  AMD creates characteristic white spots on the retina and the wet type is confirmed with flouroscene angiography. MH is obviously diagnosed with OCT scans.  I stopped going to see one Thai ophthalmic surgeon because he wrongly diagnosed AMD when I actually had impending MH and epiretinal membrane.  The correct diagnosis was confirmed by a surgeon at Moorfields on a trip to the UK and by another Thai surgeon who eventually performed both my surgeries.  The lesson to me was that there are good and bad ophthalmic surgeons. I sympathise with my fellow Brits who are dependent on the NHS which limits their choice of surgeons.  However, you are entitled to a second opinion and it is worth exercising this, if you have any doubts about the surgeon you have been asigned.