A macular hole, a hole in the centre of the retina, usually develops spontaneaously. This is often associated with a age related collapse of the vitreous body, the transarent gel in the back of the eye.A macular hole is diagnosed during the retinal examination at the slitlamp as well as the OCT. Shoud the macular hole affect visual acuity, surgery is recommended.
During surgery, the first step is to remove the vitrous body of the eye. Prof. Findl typically performs this surgery in local anaesthesia, it may also be perfromed under general anaesthesia should the patients wish. Through three small openings, the vitreous gel is cut and removed. Thereafter, the very thin innermost layer of the retina, the inner limiting membrane, ILM, is stayned with blue dye and then removed using a fine forceps. Studies have shown that removal of the ILM may lead to better visual results after surgery. Lastly, a gas bubble is injected into the eye at the end of surgery to mechanically close the whole.
Following surgery, the patient shoud stay in a face-down position for 1-2 days This helps to press the rim of the hole against the underlying layer and helps closure of the hole. Depending on the gas mixture used, the gas bubble will stay in the eye for 2-6 weeks, progressively diminishing in size. As long as the gas bubble is in the eye, vision is poor and the patient should not undertake airline flights.
Thereafter, visual acuity may increase or at least stabilize. In many cases, it may take several months to reach the final visual acuity. Concerning the visual prognosis, the primary goal of this surgery is stabilization of visual acuity and improvement of visual distortions. The prognosis is dependent on the size of the macular hole before surgery. In the case of a large macular hole, visual prognosis is guarded. A side effect of vitrectomy is the clouding of the lens, also called cataract. Cataract ususally develops within several months to a few years after surgery. Cataracts can be treated effectively with cataract surgery.