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Written by Allen Green
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The macula is at the back of the eye, situated in the middle of the retina. It is a light-sensitive layer which converts light into signals that tell the brain what we are looking at. The macula enables us to see sharp, clear images. A hole is caused when the vitreous, the gel-like substance in the eye, shrinks and starts to come away from the retina. During this process, a hole in the macula can result. This is known as a macular hole, and usually occurs as a result of ageing. Where the hole is, and how big it is, will determine how much vision is affected. Most people report weakening eyesight or seeing distorted images. In severe cases, a hole in the macula can cause loss of central vision and the ability to see finely detailed images.
A macular hole can also be called a retinal hole, a macular cyst, or retinal perforation. Macular holes are more prevalent in women than men. It is important to point out that a macular hole is not the same as macular degeneration. Macular degeneration is a different eye-related condition that also affects elderly people.
Diabetic eye disease can also cause a macular hole to develop. People who are extremely myopic (short-sighted) are also prone to macular holes.
There are three types of macular holes, namely: Foveal detachments, Partial-thickness holes, and Full-thickness holes.
The surgical procedure to repair a macular hole that has gone right through the macula is called a vitrectomy. The vitreous is removed to stop it pulling on the retina. A bubble made of gas is put in its place; this will eventually fill with the eye’s own fluids and the hole will heal. After this surgical procedure, the patient is required to stay in a face-down position. This period can vary from a few days to three weeks, depending on the individual’s recovery. This enables the bubble to rest on the macula, thereby plugging the hole. This surgical procedure, however, can cause complications, the most common of which is an increase in the development of cataracts. Other complications are retinal detachment and infection. Retinal detachment can occur during or after the surgical procedure.
Keeping the face-down position after the vitrectomy is absolutely essential. Patients who have difficulty in maintaining a face-down position for a long period may not be able to undergo a vitrectomy as the recovery process could be compromised. The best advice is to speak to the doctor as there are ways and means of making the face-down period more comfortable. There are also methods to reduce the face-down time. Patients should not fly for a few months after surgery because variations in air pressure can affect the bubble that has been inserted. |
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