Macular Hole Surgery
(For a definition of this condition and links to
see the MD Support Glossary and Eye Diseases and Conditions.)
The first hint that something was wrong with my right eye was a blurriness that I thought signaled a need to see the opthamologist for change in my eye glass prescription. I made an appointment for a routine eye exam, but soon made a startling discovery.
I was driving my car, reached up to rub my left eye and realized that the car in front of me, about a block away, had disappeared from my right eye vision. I could see every thing else, but the car was gone. When I opened my left eye again, I could see the car just fine. Wow! I drove around for a few more minutes, covering my left eye at intervals, realizing (with terror) that utility poles were distorted, signal lights were gone, signs were missing, but only with my right eye. I knew there was a serious problem with my eye. As long as my left eye was open, I could see just fine. Amazing.
I started searching the Internet for information as soon as I got home. My search led me to the Amsler Grid and I realized that my right eye vision was exactly the same as that illustrated for Macular Degeneration. To say that I was terrified is an understatement.
I had an appointment with my opthamologist the next day. He basically (or so it felt to me) dismissed me as a macular degeneration patient that could not be helped with a change of glasses or much of anything else. He did refer me to a retinal specialist, but I left the opthamologistâs office feeling very depressed and pretty much resigned to blindness.
I saw the retinal specialist the next week. After fluoroscein angiography, he diagnosed me as very early macular degeneration. He stated that the early MD might never effect my vision, but that I had another, much more important problem at this time - a full thickness Macular Hole. He told me that I had already lost approximately 75% of my central vision in my right eye. But, the good news was that he felt some of the vision could be restored by surgery.
The retinal specialist explained in great detail the surgery that would be done - a vitrectomy (removal of the vitreous gel) with the instillation of a permeable gas into my eye. He also told me that I would have to be in a face down position for approximately 10 days in order to allow the gas to rise against the macula and adhere the macula once again to the eye. He also told me that most surgical patients get approximately 50% improvement in the vision of the affected eye, which translates into a 2-3 line improvement on the standard eye chart.
Of course, I agreed to the surgery. What choice did I have? The thought of spending 10 days face down was totally depressing. But I spent the next couple of weeks trying to prepare for that post operative period.
I tried out different activities with my face down. The doctor told me I could be up and about as long as I kept my chin on my chest. So I practiced and planned.
Some of the things I did to prepare:
Arranged for the rental of a special chair and bed head rest from a massage store.
Arranged my toiletries and medications on the counter top so I could see and reach them without raising my head.
Placed my TV on it's back on the floor. My son added cable to the existing cable line so the TV could be placed close to my sofa.
Placed my microwave so it could be reached easily with my chin on my chest.
Practiced using a mirror to get things out of the freezer and cupboards.
Placed my coffee maker, coffee and filters on a low coffee table so I could make coffee without assistance.
Bought sweat suits so I could dress easily.
Checked out lots of talking books and large print books from the local library.
The surgery itself was easy. I was awake with sedation. It didn't bother me at all that someone was doing things to my eye. I went home after about 45 minutes in the recovery room.
The thing I found most difficult about the post op period was not being able to look at people I was talking to. Socialization was very uncomfortable.
I also found that my neck and lower back were very uncomfortable. Ibuprofen and a heating pad were helpful.
It seemed to me that just maintaining the position was depressing. I found myself getting very depressed even though there really wasnât any reason to be.
I thought that I would be able to use my lap top computer during the post op period, but found that it was extremely difficult to try to work with the computer.
I would not rent the special massage therapy chair again. It was expensive and I did not find it very helpful in terms of positioning. I could not have managed without the head positioner for my head.
Unfortunately, I experienced two separate incidents of detached retina after the surgery. The detachments were complications of the original surgery. The first detached retina happened 7 days after the original surgery and necessitated another surgery along with another 10 days of the face down position. No wonder I was depressed.
The second detached retina happened approximately a month after the first one. With this third surgery, silicone oil was placed in my eye instead of a permeable gas. The up side of the oil placement was that I didnât have to remain face down. The down side is that I need to have another surgery to remove the oil.
At this point in time, it is impossible to gauge if I have any real improvement in central vision with my right eye. Since the silicone oil is still in my eye, everything appears as though I am looking through a bottle of vegetable oil. I am able to read some of the letters on the first three lines of the eye chart, and this is an improvement from my pre op status. I will have to wait until the silicone oil is removed to know what, if any, true improvement has occurred.
My experience began in June of 2005 (age 69) when I noticed vision problems. My optometrist had warned me in February that I had dry macular degeneration, that I needed to monitor my sight carefully, and to call immediately if I noticed any change. On a Tuesday, my vision felt strange. I called the eye clinic and got an immediate appointment for Friday. Pictures were taken, both OCT and an angiogram, and the ophthalmologist gave me the bad news--I not only had Wet MD, but I also had a wrinkled membrane on that eye.
There wasn't much that could be done about the membrane, so the decision was made to try Macugen to stop the leaking. After the 5th Macugen shot the ophthalmologist decided to try Avastin in February of 2006. Immediately following that shot, my left eye vision deteriorated badly and showed all the symptoms of a macular hole. The operation was scheduled for June 27th.
The treatment has thankfully been modified to use a quicker acting gas and the requirement for maintaining a head down position has changed from 3 weeks to 7-10 days. Thanks to this site, I was somewhat familiar with what I needed to do. I found an equipment rental site on the Internet by searching for "macular hole." I rented a combination package consisting of the Daytimer, the Night timer, and a vitrectomy mirror. I felt that the cost was reasonable, as it included shipping both ways and arranging for the packages to arrive before the surgery so I could practice. My RS gave me tips on how to arrange my pillows so that I could sleep almost face down comfortably without any other aids. This was an enormous help. The Night timer package consisted of a cushioned face board for sleeping on a bed. This was useful to me during the day for resting my neck and upper back while reading. The Daytime package was chair with a head support. I positioned it over my coffee table and was able to use my laptop computer very easily. Both sets are very adjustable and pictures and descriptions can be seen on the Internet.
On the day of the operation, I was very nervous and had been unable to eat much the preceding week. I was given a much needed shot thru the IV line to relax, wheeled into the operating room, given a local anesthetic to deaden the problem eye, and draped with a porous mesh over the rest of the face. This turned out to give me my only discomfort, as I tend to be somewhat claustrophobic. A time or two I felt it necessary to inhale deeply, and was cautioned by the RS "Don't Move!" Other than that everything went extremely well. I returned to the room I had left earlier, got dressed, and went out to eat a big breakfast!
The eye was scratchy but not bad, and I had no need for the pain pills the RS had prescribed. I returned the next morning for a post-op examination, and then we returned home (face down for me). Follow up occurred 7 days later, and I got the news that the hole had successfully closed. My left eye is now helping rather than hindering my vision. I can read the left letters on the eye chart down to the 20/70 level, but the right side of the that eye is still blocked. My RS had warned that the Wet MD had caused permanent damage, so I wasn't surprised or disappointed. I am just thrilled, as was my RS, that I got back as much vision as I did.
Manuel Olin offers an excellent account of his macular hole surgery and recovery on his personal web site at this link.