Macular hole is a condition of the retina where a small defect in the central retina (the macula) causes vision loss. Macular hole results from an abnormal ageing process in the eye, and the precise mechanism is not well understood; very occasionally it follows trauma. However, we do know that the condition is commoner in women, and it is frequently asymptomatic – it is quite common for people to notice distortion or to have trouble reading.
Surgery for macular hole is very safe.
The operation is called vitrectomy: the vitreous (“jelly”) in the back of the eye is removed using highly specialised instruments and equipment, through 3 small “keyhole” incisions.
This allows access to a very fine membrane (the inner limiting membrane of the retina) lining the very innermost surface of the retina. This membrane is only 1-2 micrometres thick (1-2 thousandths of a millimetre) and must be grasped by very small and precisely engineered forceps, and removed manually.
After surgery, the eye is filled with gas, and most patients are instructed to remain upright when they are awake and sleep on one side or another at night. Dr Reddie does not usually instruct patients to remain face down following surgery for macular hole, as he finds he can achieve good surgical results without this position, and this is supported by the latest scientific evidence.
On average, patients can expect to gain approximately two lines of vision from the procedure – and for some people this allows them to keep driving. The rate of successful hole closure following surgery exceeds 95%.
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