The
retina, which is the inner lining of the eye,
functions very much like film in a camera. The
center of the retina which is responsible for
critical vision is called the macula. You
have been diagnosed to have a small retinal hole
in this area of the retina. Under certain
circumstances surgery can be helpful in reversing
some of the visual loss caused by this hole. The
most common cause for a macular hole to develop is
localized pulling on the retina by the jelly
(vitreous) that normally fills the entire back of
the eye.
This tugging may
initially cause mild blurring of vision as the
retina becomes thinner. If a complete hole
develops, people are very aware of a small blind
spot in the center vision and often have
distortion of vision.
Surgery
During the past 10
years, surgery to treat macular holes has become
increasingly common. If successful, some of the
lost central vision may be restored. The surgery
consists of removing the vitreous from the eye by
using very delicate surgical instruments under a
microscope. If there is any remaining tugging on
the center vision from vitreous, this traction is
released. The eye is then filled with a large,
long-lasting air bubble. The air bubble which has
been placed inside the eye provides a long-acting
splint to the macular hole and greatly increases
the chance of successful surgery . The air bubble
slowly disappears from the eye spontaneously and
may last up to six weeks. It is advisable not to
travel in an airplane while air remains in the
eye.
Head Positioning
The surgery itself
is only one part of the formula for success. The
patient's ability to position his/her head
properly following surgery is absolutely critical
to provide the best chance for long-term hole
closure with improved vision. Assuming a face
down position for a large part of the time for the
first two to four weeks following surgery permits
the bubble to float to the back of the eye and
maintain gentle pressure on the macular hold. This
keeps the hole completely closed and encourages
new tissue to grow across the hole, providing a
permanent seal.
Head
positioning is necessary not only during the day
but during the night also. A number of techniques
may be used to position the head to allow the air
bubble to work properly. During the day many
people simply place a pillow on a table and bow
forward, using the pillow to support.
At
night, sleeping on the stomach is most effective
with the forehead elevated with a pillow to aid
breathing or by turning the head to one side by
using the side of a pillow. Complete disappearance
of the air bubble may take up to six weeks, but
the most important period for head positioning in
the first two weeks.
Commonly
Asked Questions
- How
frequently is cataract formation noted?
If you have not had cataract surgery, you will
likely develop a cataract and may need surgery
in the next few months.
- How often
does retinal detachment occur? Retinal
detachment occurs in a small number of
patients and is usually easily repairable.
- How long
will I need to assume the face-down position?
In general, rigorous face-down positioning is
encouraged for 14 days.
- What
happens to the air bubble and how long will it
last? The air bubble will slowly be
absorbed by the body. It may persist in the
vitreous space for as long as 3 to 6 weeks.
- When can I
travel by air? Generally you should
not fly until the bubble is completely gone.
Your doctor may allow you to travel by air
sooner if it is safe to do so.
No portion of
this information may be reproduced without express
permission of Texas Retina Associates.
©
2000 Texas Retina Associates
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