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Macular Hole

The macula is the central area of one of the most important parts of your eye - the retina.  The retina is a thin layer of light-sensitive tissue that lines the back of the eye.  Light rays are focuses onto the retina, where they are transmitted to the brain and interpreted as the image syou see.  The macula is the portion of the retina responsible for clear, detailed vision.  


Your eye is filled with a gel-like substance called vitreous, which lies in front of the macula.  As you age, the vitreous gel shrinks and pulls away from the macula, usually with no negative effect on yoru sight.  In some cases. however the vitreous gel sticks to the macula and is unable to oull away. As a result, the macular tissue streches.  After weeks or months the macula tears, forming a hole. 


Less common caused of macular holes include injury and long-term swelling of the macula. 


In the early srages of hole formation, your central vision becomes blurred and distorted.  If the hole progresses, a bildn spot develops in your central vision and impairs the ability to see at both distant and close range.














It is important to note that if the macula is damaged, you will not lose your vision entirely.  You will still have peripheral, or side, vision. 













Your ophthalmologist will diagnosie a macular hole by looking inside your eye with a special instrument.  The doctor may perform a test called optical coherence tomography, or OCT, to scan and examine yoru retina.  OCT used light waves to reveal specific layers of the retina. 


Vitrectiomy surgery is the most effective treatment to repair a macular holeand possibly improve vision. The surgery involves using tinyinstruments to remove the vitreous fel that is pulling on the macula.   The eye is then filled with a special gas bubble to help flatten the macular hole and hold it in place.













You must maintain a constant fasce-down position after surgery to keep the gas bubble in contact with the macula. This can range from a few days to a few weeks, depending on your surgeon's recommendation.  A successful result oftern depends on how well this position is maintained.  The bubble will then slowly dissolve on its own. 


If you have a gas bubble, you cannot fly in an airplane until the gas bubble has dissolved, as a rapid increase in altitude can cause a dangerous rise in in eye pressure.  You must also not underfo general anesthesia using nitrous gas, though it is generally safe to have general anestjesia without using nitrous gas. 


You can expect some discomfort after surgery.  You will need to wear an eye patch for a short time.  Your ophthalomogist will presribe eyedrops for you and advise you when to resume normal activity.  


As the macular hole closes, the eye slowly regains part of the lost sight.  The outcome for vision may depend on the size of the hole and how long it was present beofre surgery.  The amount of visual recovery can vary.  


Some of the risks of vitrectomy surgery include infection of eye, bleeding of the eye, retinal detachment, high pressure in the eye, poor vision, and/or accelerated cataract formation.  It is important that you discuss the potential risks and benefits of this procedure with your doctor before making a decision regarding treatment. 

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