Following your macular hole operation

Immediately after your macular hole surgery
The day after your macular hole surgery
How quickly will your vision improve?
When can you resume normal activities?
Driving and travel
What can you do to help make the operation a success?
What are the risks and complications?

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Immediately after your macular hole surgery

After the operation you will return to the ward with a pad and plastic shield covering the operated eye. This remains in place overnight. You will be given a combination antibiotic and anti-inflammatory eye drop and a pressure lowering drop to take home, with written instructions on how to instil these and the frequency with which they should be used. We will make sure you know how to care for your eye when you get home.

Whilst resting after the operation you will be offered refreshments. You may leave the hospital when you feel ready.

During the first few hours after your operation the eye may feel sore. This is nothing to worry about and your normal headache tablets should settle any discomfort.

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The day after your surgery

The pad covering your eye should be removed the morning after your surgery. You do not need to use it thereafter, although some patients prefer to wear the clear plastic shield for the first few nights for peace of mind.

You may find the eye a little sticky and there may have been a slight discharge overnight. This is quite normal and you should cleanse the eye only if necessary, by wiping gently across your closed eyelids with cotton wool dampened with clean water.

You will then need to start your eye drops, following the detailed written instructions given to you before you left hospital.

If you are running out of drops before your appointment at the clinic, you can request a repeat prescription from your GP.

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How quickly will your vision improve?

No clear vision is possible in the first few days as the gas bubble completely fills the eye. As the gas bubble is absorbed, vision returns giving the impression of a horizon gradually working its way down from the top.

It can take as long as three weeks for the gas bubble to clear from half of the eye, (the upper half of your world appearing normal and the lower half blurred and wobbly) depending on the type of gas required. The bubble is actually floating to the top of the eye although you will perceive it as being in the lower part of your visual field. It can take up to eight weeks for the bubble to disappear completely.

Occasionally, we will use a shorter acting gas that re-absorbs more quickly. This will be explained if applicable to you.

Your final visual result may not be known for several months following surgery. An average patient regains two or three lines on the optician’s chart but more importantly, as distortion is minimised, the two eyes can work together effectively.

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When can you resume normal activities?

You may return to your normal daily activities as soon as you feel ready to do so, but specific written instructions will be given to you on discharge from hospital. As a guide, however, for the first few weeks you should refrain from swimming, strenuous activities, high impact sports, heavy lifting and wearing eye make-up.

If for any reason you are admitted to hospital whilst the gas bubble is present, you must mention this to your surgeon and anaesthetist as certain anaesthetic agents can be absorbed into the eye, causing a dangerous pressure rise. Alternative anaesthetics are available.

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Driving and travel

It is vitally important that you do not fly until the gas bubble has re-absorbed as altitude can cause a pressure rise within the eye and irreparable damage.

You will be unable to drive for the first two or three weeks. Following this post-operative period, your ability to drive will depend upon a number of factors including the vision in your other eye and the level of your vision when using both eyes together. The field of vision will be impaired and the movement of the gas bubble very distracting.

If you are in any doubt regarding your visual status you should refrain from driving until you have been seen for review in the clinic.

Please also remember that you will need to continue putting drops in the eye for approximately three to four weeks after surgery.

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What can you do to help make the operation a success?

Closure of the macular hole can be assisted by correct posturing to help the bubble press against the macula. Usually this is done simply by avoiding lying flat on your back at night. You may have heard that some patients are advised to posture “eyes down” but this is not usually necessary with our technique.

Following your surgery it is very important that you instil the eye drops as instructed, as this will help prevent any complications such as infection or inflammation in the eye.

You should avoid knocking or rubbing your eye, but you may touch the surrounding area. Although it is safe to have a shower or bath, take care when washing your hair to avoid getting soapy water in your eye.

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What are the risks and complications?

The aim and potential outcome of vitrectomy surgery for macular hole will be discussed with you in clinic and again prior to your operation.

Our team operates from modern private hospitals where the equipment and products used in the operating theatre are of the highest standard. Every effort is made to minimise risk and ensure your operation is safe. Serious problems during or after surgery are rare, however every surgical procedure has risks and potential complications.

Complications early in your recovery:

  • Initial poor vision. It is not possible to see clearly through a gas bubble and vision will be compromised until spontaneous re-absorption occurs.

  • Bruising of the eye or eyelids. The local anaesthetic may cause some bruising around the eye, particularly on the lower lid. The sclera may be red where the tiny incisions are made into the eye. This usually resolves completely within the first month.

  • A temporary increase in the intra-ocular pressure in the eye. This necessitates an additional course of eye drops or tablets. If a gas bubble is used, these treatments are given routinely as a precaution.

  • Allergy to eye drops. Ocular allergy typically causes lid swelling, itching or redness. If this happens, please let us know and we can prescribe an alternative. Some patients are allergic to the preservative used in eye drops and if you have previously had a reaction, please inform us prior to surgery so that we can prescribe a preservative-free option.

  • Endophthalmitis. Infection in the eye is a very rare, but potentially devastating complication affecting fewer than one in a thousand cases. Increasing discomfort, increasing redness of the eye or worsening discharge should be reported immediately.

  • Cystoid macular oedema. Swelling of the central macular area of the retina causes blurred vision. This usually resolves within a few weeks of using additional eye drops.

Complications late in your recovery:

  • Failure of hole closure. The success rate for first time closure of a macular hole is between eighty and ninety per cent, depending upon a number of factors including duration of symptoms and the size of the hole. If the first procedure fails, there is still a high chance that a second attempt will be successful.

  • Retinal detachment. Vitrectomy surgery involves the insertion of instruments into the vitreous cavity of the eye which carries a small risk of tearing the peripheral retina. Although normally identified and treated at the time of surgery, retinal detachment can occur months or even years later. Any increase in floaters and flashing lights, or the appearance of a shadow spreading inwards from the edge of vision, should be reported urgently.

  • Glaucoma. Any ocular surgery can increase the risk of glaucoma in later years. Glaucoma is damage to the main optic nerve of the eye, caused by an unsuitably high pressure. It can nearly always be controlled with eye drops, although prolonged or even indefinite use may be required.

  • Dry eyes. This is a common symptom with increasing age, for which many sufferers use simple lubricating drops. Interfering with the conjunctiva on the surface of the eye can upset the production of mucus, which is an important constituent of the tear film. In most cases this is temporary, responding to simple measures such as ocular lubricants and warm compress bathing. We will advise you on a treatment regime if required.

Information explaining how to care for your eye together with contact telephone numbers will be given to you on discharge from hospital.

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