Macular Holes 

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The retina is the inner lining of the eye and functions very much like film in a camera. The area of the retina which is responsible for critical vision is called the macula. You have been diagnosed to have a small retinal hole in this area of the retina. Under certain circumstances, surgery can be important in reversing some of the visual loss caused by this hole. The most common cause for a macular hole to develop is localized pulling on the retina by the vitreous jelly that normally fills the eye. This tugging may initially cause mild blurring of vision as the retina becomes thinner. If a complete hole develops, people are very aware of a small blind spot in the center vision and often have distortion of vision.

Surgery

Surgery to treat macular holes has become increasingly common during the last ten years. If successful, some of the lost central vision may be restored. The surgery consists of removing vitreous from the eye by using very delicate surgical instruments under a microscope. If there is remaining tugging on the center vision from vitreous, this traction is released. The eye is then filled with a large, long-lasting air bubble. The air bubble which has been placed inside the eye provides a long-acting splint to the macular hole and greatly increases the chance of successful surgery. The bubble slowly disappears from the eye spontaneously and may last up to six weeks. It is advisable not to travel in an airplane while air remains in the eye. 

Head Positioning

The surgery itself is only one part of the formula for success. The patient’s ability to position his/her head properly following surgery is absolutely critical to provide the best chance for long-term hole closure with improved vision. Assuming a face-down position for a large part of the time for the first seven to ten days following surgery permits the bubble to float toward the back of the eye and maintain gentle pressure on the macular hole. This keeps the hole completely closed and encourages new tissue to grow across the hole, providing a permanent seal. Head positioning is necessary not only during the day but also during the night. A number of techniques may be used to position the head to allow the air bubble to work properly. During this time, many people simply place a pillow on a table and lean forward, using the pillow to support the forehead. Special chairs are available from CFR for use during the period of time that is necessary for face-down positioning.

At night, sleeping on the stomach is most effective with the forehead elevated with a pillow to allow breathing or by turning the head to one side by using the side of a pillow. Complete disappearance of the air bubble may take up to six weeks, but the most important period for head positioning is the first week.

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