Advice after your nerve block for surgery
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Introduction
The retina is the light sensitive layer at the back of the eye and the macula is the centre part of the retina. In many ways, it is similar to the film in a non-digital camera. The macula is the part of the retina with which you are reading this leaflet and provides you with the most sensitive vision. A macular hole occurs when the macula splits at its centre. It is caused by the jelly within the eye (the vitreous) pulling on the macula, and this is not a feature of macular degeneration.
Who gets macular holes?
Macular holes most often occur in patients who are between 60 and 80. More women are affected compared to men and it is more common in longsighted people. Some other causes include severe injury to the eye, in very short-sighted patients, and rarely following successful retinal detachment surgery.
How does a macular hole affect your vision?
Firstly, the quality of the image is very poor. Secondly, straight lines tend to become distorted with a bowing appearance. Thirdly, it is not unusual for patients to develop a central missing patch in their vision.
Many people with a macular hole are very aware that the poorer eye interferes with or gets in the way of the better eye. As a result, even though the macular hole only affects one eye, the vision with both eyes open can be very unsettled. Some people will cover or close one eye in order to get over this effect.
What happens to a macular hole if it is not treated?
Most macular holes do not resolve on their own. Macular holes only affect the central part of vision and as such, patients suffering from them do not go blind. However, macular holes do become larger over time and can become too large to operate on if left for too long.
Can I get a macular hole in my other eye?
Yes, this is possible. Unfortunately, about 1 in 10 people who develop a macular hole in one eye will develop a hole in the other eye. There are some circumstances in which we are able to say that development of a macular hole is very unlikely to occur in the other eye. This relies on the result of an examination of the vitreous jelly within the eye.
What happens after a macular hole is treated?
About 90% to 95% of patients with a macular hole can be successfully treated with one operation. Success means that the hole is closed. About 70% of patients who undergo a successful macular hole operation are able to read two or three more lines on the standard vision test chart.
A major benefit in addition to improvement of vision is that the distortion tends to be much less after surgery. The eye with the macular hole tends to interfere much less with the other eye. It is important to know that the vision in the affected eye does not usually return to normal, even after successful surgery.
Possible complications
- Infection
- It occurs in less than 1 in 1000 patients who undergo an epiretinal membrane operation. This tends to occur in the 2 - 5 days after the operation. If caught early enough, then most infections within the eye can be treated successfully. Unfortunately, infection can be a devastating complication of surgery. Overall, less than 1 in 500 could expect to end up worsening after surgery.
- Glaucoma
- Raised pressure may occur in an eye that has undergone a vitrectomy. In most cases, this is transient and can be successfully treated with just eye drops. In less than 1 in 100 patients who undergo vitrectomy may have damage to the optic nerve as a consequence of high pressure. The severity varies greatly from person to person. Once you are discharged you should visit your option yearly.
- Retinal detachment
- It occurs in about 1 in 100 people undergoing an epiretinal membrane operation. The vast majority of retinal detachments are repairable, but this can potentially be a blinding complication and surgery is needed to repair the detachment.
- Bleeding
- In rare cases, 1 in 1000, there may be bleeding in the eye. In severe cases, this can lead to blindness.
- Cataract
- Cataract (clouding of the lens) progression can be quite rapid and may need a further operation to remove it. However, combined cataract surgery with epiretinal membrane surgery is sometimes performed.
Lying flat on your front after the operation
If your macular hole is small (less than 400 microns), it may not be necessary to lie on their front. However, for large macular hole (greater than 400 microns), studies have shown that posturing may be beneficial. Therefore, we ask patients to keep face down a total of 3 hours in the morning, and 3 hours in the afternoon; other times can be spent sitting up or walking. We ask you to do this for up to 5 to 7 days. Your surgeon will instruct you on what do to.
At night, you are asked to sleep on either the right or left cheek and not flat on your back. Please refer to the ‘Post-operative advice following macular hole surgery’ for more information.
Things to avoid after the operation
Your surgeon will advise you on what to do after your surgery.
There will be a gas bubble which can last between 2 - 12 weeks. With gas bubble inside the eye, the patient cannot fly and drive. Also it's important to tell the anaesthetic doctor if the patient is having another operation under general anaesthetic while the gas is still in the eye.
Most other activities are fine to do, there is no need to be concerned about bathing, going out for a walk, and travel by road, rail, or sea. We do ask patients not to swim for 2 months to prevent any unnecessary infection from occurring.
How long do I spend in hospital?
Most patients will have the operation as a day case (no overnight stay). However, if there is no escort to take the patient home or if the patient is unfit to go home, staying overnight to ensure safety will be necessary.
Eye drops after operation
Most patients will have a combination of an antibiotic and steroid eye drop for 4 weeks. Occasionally, the pressure within the eye can be raised after surgery. If this occurs, pressure lowering drops will be prescribed as well.
Post-op appointments
Usually the first visit will be the day 1, then 2 weeks after the surgery and then about three months later. However, there're many variations to this regime.
Will I have to get my glasses changed?
Most people have a change of glasses after the surgery. We usually recommend that people think about changing their glasses after their 3-month follow up.
If you have any concerns after your operation, please contact the staff in the eye treatment centre on the following numbers
| From 9am to 5pm Monday to Friday: | 0300 373 5884 |
| From 5pm to 9am and at weekends: |
0300 614 5000 and ask for the Eye Doctor on call |
Contact us
If you have any queries relating to this information, please contact the Ophthalmology service.
About this information
Service:
Ophthalmology
Reference:
QQ/038
Approval date:
5 August 2024
Review date:
1 July 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.