If you are told, you need macular hole surgery – a vitrectomy – you will likely have a ton of questions buzzing in your head. You might wonder how the procedure is performed, if it will be painful, why your surgeon needs to fill your eye with a gas bubble, or how long the recovery period is.
You will probably also wonder if you will regain your eyesight and when it might return to normal. All of this is normal. Fortunately, the more you know about what is happening throughout the process, the more likely you are to feel confident and prepared for your macular hole surgery.
Here’s a step-by-step look at what you can expect, including why surgeons place a gas bubble in your eye, what’s involved in recovery, and what you can expect when you resume your normal routine.
When Does a Macular Hole Need Surgery?
Not all macular holes behave in the same manner. Your retina specialist will take into account factors like the size of the hole, the stage of the hole, your symptoms, how long the hole has been there, and how your hole looks on the OCT when suggesting treatment.
Your doctor will take all of these factors into consideration, review your OCT results with you, and assess the overall health of your eye when recommending how your hole should be treated.
What Is Vitrectomy Surgery for a Macular Hole?
Vitrectomy is a surgical procedure on your vitreoretinal eye that gives the surgeon access to the back of your eye to remove the tissues forming the macular hole.
If your surgeon performs vitrectomy surgery for a macular hole, they will remove the vitreous gel from your eye. Your surgeon will often remove the inner limiting membrane (ILM) and put a gas bubble into your eye to help support your macula as it heals.
Another term for vitrectomy is pars plana vitrectomy (PPV). Still, your retinal specialist will use a technique that is appropriate based on what your retina looks like.
Once you know the general process, it makes it much easier to answer: what do they do inside the eye, exactly?
How Does Vitrectomy Repair a Macular Hole?
Vitrectomy is used to clean the retina and vitreous so a macular hole can successfully heal. Depending on the situation, there may be a few steps, but several generally apply.
1. Anesthesia
Your surgical team will use anesthesia to manage the discomfort of the procedure. You should have already gone over the anesthesia that is best suited to your procedure with your surgeon.
2. Removing the Vitreous
The surgeon is going to take out all the vitreous gel that is in the back of the eye. This frees up the macula and loosens the traction from the vitreous gel pulling on the retina. It also provides the working room for him to do all the other repairs.
3. Peeling the Internal Limiting Membrane
Sometimes the surgeon may also peel the inner limiting membrane (ILM) off the retina around the macular hole. This is because the ILM is a very fine layer at the back of the eye’s retina. Lifting and peeling it can relieve the pulling on the hole, which may help it close. Your surgeon might inject some colored dye into the eye to allow you or them to see this fine membrane more clearly during the operation.
4. Placing a Gas Bubble
A surgeon can introduce an artificial gas bubble into the eye. This bubble supports the macular area until the hole has healed, and it slowly shrinks and goes away on its own. Every surgical step has a role, and the gas bubble in particular has a role of its own post-op.
Why Is a Gas Bubble Used After Macular Hole Surgery?
A gas bubble acts as a temporary internal scaffold as the hole heals. You might even be aware of it after the surgery – it will look like a line or shifting barrier that moves around as you turn your head. Your vision might stay cloudy with it in there.
It will dissolve over time, depending on the specific gas and treatment plan. Since the bubble interferes with your vision and responds to pressure changes, it results in some necessary post-surgical guidelines and safety precautions.
Do You Have to Lie Face Down After Vitrectomy?
Your retinal surgeon will usually advise you to lie on your stomach so that the gas bubble can apply pressure on the macula. Keep in mind that your position and daily routines will differ from patient to patient. Some specific eye features or surgery methods might result in a different schedule for you.
Your instructions are specific to your eye and surgical care, and not everyone else’s recovery is the same. If you are having trouble maintaining the recommended position, please get in touch with your surgical team. There are safe positioning variations for most circumstances. The positioning routine you maintain is just one aspect of healing your eye.
What Is Macular Hole Vitrectomy Recovery Like?
Your eye will need time to recover after your vitrectomy to repair the macular hole. During that time, your vision will continue to be blurred from the gas bubble inside your eye. The macula will likely take time to finish healing after it has closed.
Your doctor will provide post-operative care instructions regarding medications, position and rest, activity, and follow-up appointments. Following these instructions can help you care for the healing eye.
Immediately After Surgery
You might notice a little irritation or discomfort in your eye and, while it may still feel blurry, you may not see sharply yet.
The eye surgery team will go through exactly what symptoms to look for and which symptoms mean you should call their office.
During the First Few Weeks
In the coming weeks of your recovery, you might:
• Be prescribed eye drops
• Need to follow positioning instructions
• Have activity limitations
• Undergo follow-up appointments for your eye
• Experience visual disturbances
• Still have the bubble monitored
Do not measure your recovery against someone else – we are all different and heal differently based on your surgery.
As the Gas Bubble Shrinks
As your eye absorbs it, the bubble slowly diminishes.
As the bubble reduces in size, you will likely experience the world changing visually. Your retinal specialist will continue to check the macula at your follow-up visits and OCT scans.
Healing continues even after the bubble goes. Visual progress can continue after anatomical healing.
When Will Vision Improve After Vitrectomy?
Vision does not immediately come back after macular hole surgery. Often, the gas bubble obscures your vision, leading to temporary blurred vision, and the macula takes time to heal.
What outcome is best for your vision will vary with the size and longevity of the hole and how healthy your retina was before surgery.
If your macular hole closes, this will not automatically mean that your vision has fully recovered. Your retina specialist will check for anatomical closure of the hole and visual recovery with each follow-up.
Understanding this difference will help you avoid jumping to early conclusions.
What Are the Risks of Vitrectomy Surgery?
Vitrectomy is a regular vitreoretinal surgery. However, all surgeries come with inherent risks, and here are a few you might encounter after vitrectomy:
• New development or worsening of a cataract.
• Changes in eye pressure.
• Development of retinal tears.
• Retinal detachment.
• Inflammation or infection.
• A new macular hole or the existing one not closing completely.
• Incomplete visual recovery.
Your risk will differ from anyone else’s, and it will depend on your eye, the macular hole, and the surgical procedure your retinal surgeon uses. Your retinal surgeon can go through the potential benefits and risks with you and give you a realistic understanding of what to expect.
Can a Macular Hole Develop in the Other Eye?
Yes, Since a macular hole can occur in either eye, your retina specialist will likely examine both eyes throughout your follow-up visits. Let your doctor know if you develop central distortion, fuzzy vision, problems reading, or if straight lines now look warped. Routine retinal exams can help your specialist spot any changes in either eye.
Retina Vitreous Associates of Florida — specialized retinal care for the vision you depend on.
Considering a macular hole diagnosis is daunting, and so too may seem the possibility of surgery. Understanding the vitrectomy procedure in layperson’s terms can help you approach treatment options with more ease.
If you have a macular hole diagnosis or have been told that a doctor may suggest surgery, the experts at Retina Vitreous Associates of Florida can provide you with dedicated retinal care involving the retina and the vitreous body.
If you are dealing with macular holes and are searching for answers or guidance, speak with the RVAF team today. They can guide you through treatment and procedures.
Frequently Asked Questions
1. What is vitrectomy surgery for a macular hole?
Vitrectomy surgery is done to close a macular hole where part of the vitreous gel has been removed from the eye. The surgeon can also remove the ILM and a gas bubble to aid closure.
2. How long does recovery take after macular hole surgery?
Everyone is different. Your vision will be blurry while there is gas inside the eye, and you may notice ongoing improvement in your vision after the hole is closed. Be sure to discuss your individual expectations with your ophthalmologist.
3. Do you have to lie face down after macular hole surgery?
Recovery differs in each person. There can still be some blurriness while the bubble is there; picture clarity may also improve for some time after the closure. Your doctor or surgeon will guide you.
4. How long does a gas bubble stay in the eye?
The gas bubble should resolve gradually; the period depends on the gas you have and the particular operation you had. Your ophthalmologist will advise when you can expect the bubble to disappear.
5. Can you fly after vitrectomy for a macular hole?
No. You must not travel by air as long as there is an expansile gas bubble in your eye. Low cabin pressure will cause the bubble to increase in size, which can significantly increase the pressure within the eye.