Macular Hole

I just want to add for those preparing to have MH surgery that you might be able to see the instruments going into your eye and performing the procedure. My surgeon said this is quite rare but I was able to see the instruments very clearly in both of my MH operations. Because I didn't expect it I was quite alarmed the first time but in the second operation I found it quite reassuring to have a ring side sight and know exactly where the surgeon was in the procedure.  I could see a giant looking tube coming in and doing something, which must have been the vitrectomy cutter grinding up the vitreous into small enough pieces to aspirate up through the tube.  Then a syringe came in and injected blue dye to tint the transparent epiretinal membrances. The dye floating around in my eye looked like one of those old hippy style oil lamps.  Then came the giant forceps carefully peeling away the blue tinted membrane and taking it out piece by piece, occasionally dropping a piece, grabbing it back and whipping it away.  Finally came another syringe to inject the SF6 gas and I know the surgeon was done before he told me. It is like looking up from the bottom of a swimming pool about 10 feet deep but actually the viewpoint must be the optic nerve looking up to the top of the macular which is only 252 microns or quarter of a millimeter thick.  If this happens to you, just relax and enjoy watching the surgeon at work as if you are looking at a YouTube clip.  There is no blood or mess.  During the cataract procedure all you see is the bright lights of the operating theatre. 

Someone asked if he could lie still for 60-90 minutes on the operating table under local anasthaetic.  Both my procedures took 90 minutes each and I had the same concerns but the answer is that you can.  Make sure that you don't drink too much water before the operation and avoid tea and coffee, which are diuretics, beforehand to prevent a call of nature.  I suffer from blocked nose often. So I cleaned out my nostrils with refrigerated saline solution a few hours before the op which meant I was breathing easily and my nose was not running.  Don't do this just before the op, as your nose may run for about an hour after the saline irrigation.  I did need to cough once during the second op. So I started clearing my throat and the surgeon asked if I was OK.  I told him I felt a cough coming on, so he stopped work for a bit and allowed me to raise my head and cough.  However, if you are infected a cold or cough, you should tell the surgeon beforehand and he will probably reschedule your operation, as infections are extremely dangerous for you and for other patients.  In both ops I started to feel slight sharp pain about an hour in.  There was no prearranged signal but I made a slight noise and the surgeon asked if I felt anything. When I said yes, he gave another injection of the nerve block which solved the problem and you don't feel the subsequent injections once you have already been numbed.  This is very likely to happen if you have cataract and MH procedures at the same time due to the length of the operation.  The pain is not excruciating, so don't worry too much about it happening.  Just make sure the surgeon knows your sensation is starting to return.

Finally don't think too much about your vision as the gas bubble starts to shrink.  You will not get a true picture of it until the bubble has gone completely.  Even then don't expect too much.  The main objective of this exercise to prevent your vision getting worse.  There is a good chance it will actually end up better than before the surgery but your objective should just be maintaining it the same.  However, you must bear in mind that it takes some time for the scab over the hole to heal and that it will turn into scar tissue which will leave a slight impairment in your central vision, depending on how big the hole was in the first place. The other factor is how big was the gap behind the surface of the macular and how long it takes to drain it and how perfectly this process takes place. Thus it can take up to two years for your vision to get as good as it's going to be as a result of the operation.  Have patience.  

Good luck to all who are reading this to prepare themselves for surgery.