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Dr. James
Dr. James, Board Certified Ophthalmologist
Category: Eye
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Experience:  Eye Physician and Surgeon
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My doctor diagnosed a macular hole. This cominh 3 months after

Resolved Question:

\My doctor diagnosed a macular hole. This cominh 3 months after last retinal surgery. i had five previous surgeries. How can a macular hole begin if the common reason is vitreous traction? since I would have no vitreous left after previous vitrectomies. What else might have created the 'hole"? Thank-you.
Submitted: 4 years ago.
Category: Eye
Expert:  Dr. James replied 4 years ago.
Hello,

Are you still needing assistance?
Customer: replied 4 years ago.
Yes, please. My doctor was unable to give me a clear reason for the macular hole developing.
Expert:  Dr. James replied 4 years ago.
What retinal surgeries do you have before?
What is your current vision?
How long after the surgeries before developing the macular hole?
Customer: replied 4 years ago.

I had 5 surgeries in 2008 because of multiple failures of the retina to stay in place.Thru the winter my retina stayed in place Then, in June 2009 I had insertion of lens due to cataract and the oil in my eye replaced with what? a saline solution?

Currently my central vision in right eye is blocked by a dark spot. Vision around the dark spot is like looking thru a cocktail glass.

I only realized the dark central spot at the check up and eye scan on September 23rd. Prior to that I thought the whole view was like looking thru a glass. Since my doctor had said recovery could take over a year, I wasn't too concerned. I decided I must be patient.

What i'm trying to get at is why the macular hole could develop if there was no vitreous in the eye to pull on the retina. I wonder if i can expect this to reoccur even following a successfull surgical outcome. My surgery is next week. Looking forward to your reply.

Expert:  Dr. James replied 4 years ago.
Hello,

Your question is quite reasonable. You are correct in that macular hole is thought to be due to the tractional forces caused by the separation between the vitreous and retina. During vitreoretinal surgery, one of the goals is to remove as much vitreous as possible and induce a separation between the macula and vitreous. The vitreous is clear however, and sometimes it is difficult to remove all of it.

A spontaneous macular hole in your situation is not a common event. So it can be due to residual vitreal traction. A second explanation could be due to the surgeries themselves. With each surgery, irrigating fluid is flushed through the eye. This could have started a small hole and resulted in the larger hole that you have now. It is doubtful that a macular hole could have been prevented.

Like I said, your situation is not common. Surgery will attempt to remove any remaining vitreal traction and strands. Gas will be injected in your eye and you'll need to be in a head down position for a few weeks after the surgery to allow the gas to rub up against the hole. This causes some irritation to the macula and helps induce closure.

Remember to press the green ACCEPT button. It was a pleasure helping you with your question. Best wishes to you. Feel free to ask any additional questions.
Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2282
Experience: Eye Physician and Surgeon
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