Macular hole, Epiretinal Membrane & Vitreo-macular traction
Macular hole
Age is the most common cause of macular hole. As we get older, the vitreous begins to shrink and pull away from the retina. Sometimes the vitreous can stick to the retina, this causes the macula to stretch and a hole to form. The symptoms may not be noticed until the problem is too advanced if the fellow´s eye vision is good and if vision is not checked separately in both eyes. Vitrectomy surgery is required to close the macula hole and consequently improve the vision. Visual recovery will depend on how long the problem was untreated and the vision may not be improved significantly if the problem existed for longer than 6 months
Surgery
The surgery consists in using 3 small ports for the micro-instruments to remove the gel (vitrectomy), remove the internal limiting membrane and inject short lasting gas ( 2 weeks) to help to close the macular hole. Positioning face down for 2 days is advised (45-50 min every hour having a rest 10-15 min daytime and sleeping right or left cheek to pillow). Sleeping on the back should be avoided for the first 2 nights
The eye pad needs to be removed the following day after surgery so the antibiotic drops treatment could be started. Vision is expected to be blurred due to the bubble of gas for the first 2 weeks
General risks
of Infection, Bleed, Retinal detachment are very low but will be discussed prior to surgery
Follow ups will be arranged week 1, week 3-4 and week 8
Epiretinal membrane
Epiretinal membrane is a scar tissue on the surface of the retina, which causes swelling of the retina. When is interferes with the vision or causes distorted images, surgery may be required to remove the scar tissue and release the retina
Surgery
The surgery consists in using 3 small ports for the micro-instruments to remove the gel (vitrectomy), remove the epiretinal membrane and inject the bubble of air or short lasting, 2 weeks, gas. No positioning is required and the vision should be back to normal after 1-2 weeks. However, the distorted vision will be improving gradually during the following 2 months after surgery. Some patients could continue improving visual acuity during several months following the surgery
General risks
of Infection, Bleed, Retinal Detachment are very low but will be discussed prior to surgery
Vitreomacular traction
Vitreomacular traction is a condition where the vitreous is stick to the retina. The macula is pulled and elevated by the gel. The surgery (vitrectomy) is advised to correct this condition when the vision is deteriorated, patient is very symptomatic for distorted images or macula hole is developed. Generally, the initial attitude with early stages of vitreomacular traction is watch and wait the gel is pulled away by itself, which happens in some cases
Surgery
The surgery for vitreomacular traction is very similar to macular hole surgery.
The surgery consists in using 3 small ports for the micro-instruments to remove the gel (vitrectomy), remove the epiretinal membrane if exist and inject the bubble of air or short lasting bubble of gas. Positioning face down as for Macular Hole surgery is advised for 2 days, sleeping right or left cheek to pillow for 2 days as well. Vision should be back to normal after 2 weeks. OCT retinal scan is required to assess the macula after 2 weeks
General risks
of Infection, Bleed, Retinal Detachment are very low but will be discussed prior to surgery
What to expect from retinal clinic consultation
During the consultation I have to examine both the front and back of your eyes
I usually use pupil dilation drops so that I can examine the lens and the retina, including the optic nerve. Your vision will be blurred during at least 2 hours (up to 6 hours) after drops, so you will not be able to drive after consultation for that period of time
OCT scan of the retina could be done the same day of the consultation and it gives an accurate information of the shape and size of the macular hole and helps to predict the surgical results and, also, to choose and plan the surgical technique of the repair