The treatment of a macular hole involves several steps.
as with all vitrectomies, the first step is to set up three ports, allowing for the insertion of an infusion cannula, and various instruments. These initial steps are shown under the “videos” section of NaderMoinfarMD.com.
After the jelly portion of the eye, called the vitreous, is removed, steroids are sometimes used in the eye to help identify and remove any remaining pieces of the vitreous; this step can also be seen under the videos section of this website.
In order to maximize the success of closing the macular hole, many surgeons, including myself, will use a green dye to help stain a very fine and delicate tissue, called the internal limiting membrane; removal of this tissue is believed to improve the chances of surgical success.
As you can see from my video, once the tissue is stained, it can be very delicately lifted and peeled using forceps. Sometimes, the tissue can be rather sticky, so great care is often needed to prevent injury.
Once this is completed, the eye is then filled with gas, which is helps provide a surface along where the edges of the hole can come together. I usually ask patients to try to keep their face down whenever they can, for about five days.
In almost all cases, macular hole surgery is done with the patient only lightly sedated, and the eye is made comfortable with the use of local anesthetics. This surgery is done as an outpatient, meaning that the patient does not have to remain in the hospital. In most cases, the patient will usually be on their way back home within an hour after the surgery is completed.
You will probably see a lot of different recommendations on face down positioning after macular hole surgery, and this is a frequent source of confusion, and concern, for patients. Unfortunately, there are no clear set standard as to how long, if at all, face down positioning is necessary. Some surgeons don’t advise any at all, while some advise for up to two weeks. In my experience, this extreme is neither necessary, practical, or beneficial. All I ask is that a patient do the best that they can, for about three to five days; I ask that they try to keep their face down for as long as they can, then take a break for as long they feel is necessary to recharge themselves. In most cases, this is more than enough. Ultimately, the key is mindful surgery, by a caring and competent surgeon