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An Overview of Macular Hole Surgery

written by: AlyssaAst • edited by: dianahardin • updated: 2/28/2011

When a macular hole occurs in the eye, macular hole surgery is needed to seal the hole. This procedure is considered to be safe, but certain complications can occur. When performed, vision can be restored.

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    Macular hole surgery is needed to repair macular holes. A macular hole occurs when the nerve cells of the macula, the small area of the retina, separate from each other. A macular hole can occur for a number of reasons but is often the result of an underlying medical condition that affects the eye or an injury to the eye. In some people, a macular hole develops as the result of the aging process.

    A macular hole can cause a number of symptoms, including decreased vision, changes in vision and the appearance of black spots. Often, people feel as though they are looking through thick fog. Most often, a macular hole only occurs in one eye.

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    Macular Hole Treatment

    Very rarely, treatment for a macular hole isn’t recommended. In most cases, macular hole surgery is recommended. A vitrectomy is used most often to repair a macular hole. This surgery is generally performed under local anesthetic, which allows the patient to remain awake but won’t feel discomfort from the procedure. This surgery is 90 percent effective for treating macular holes in patients and vision can be restored.

    To conduct the surgery, the surgeon uses small instruments to make small openings in the eye. A special instrument is then inserted into the holes to suction the vitreous fluid from the eye. In some cases, tissue may need to be removed from areas near the macula as well. By removing the tissue, the hole can be pulled together to close without causing any additional tearing. To complete the procedure, sterile gas is then inserted into the eye to replace the vitreous fluid that was removed. This allows the eye to maintain its pressure.

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    Recovery

    In order to recover from macular hole treatment, the patient needs to remain in a face-down position for a minimum of two weeks to allow the gas bubble within the eye to remain in place, allowing the hole to heal. As the hole heals, the gas bubble will go away on its own as it is replaced by the natural fluids within the eye. For quite sometime after the surgery, it is advised for the patient not to travel. Change in pressure can cause the gas in the eye to expand, which can further damage the eye.

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    Risks and Complications

    While surgery to repair a macular hole is considered safe, there are certain risks and complications that can occur. After the surgery, an infection can develop. Retinal detachment can occur as well. Luckily, both of these complications are treatable. Cataracts is associated with this surgery but can be reversed after the eye has fully healed. Those who have previously had a macular hole have a 10 percent increased risk for developing a macular hole in the other eye at some point. Regular eye examinations are needed to monitor a macular hole and to check for new holes in the future.

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    References:

    "Macular Hole" Cleveland Clinic

    "Macular Hole" eMedicine

    "Macular Holes" AllAboutVision