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Dr. PG
Dr. PG, Ophthalmologist
Category: Eye
Satisfied Customers: 2337
Experience:  MBBS, MD (Ophthalomology)
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My wife had a vitrectomy to repair a full thickness macular

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My wife had a vitrectomy to repair a full thickness macular hole 11 days ago (an idiopathic macular hole in that it was not caused by any underlying condition). She still sees the hole (although she believes its characteristics are different and the gas bubble is shrinking faster than normal (although the rate of shrinkage recently appears to be decreasing). What should she expect in terms or improvement at this stage. Thank you for your time and attneion to this matter.
Vitrectomy with gas injection is a major surgery. 11 days after surgery she will not have a good vision as yet. It is too early to determine her vision potential. The gas does take time to absorb fully. It can take upto 14-20 days in some cases. Also there is some edema in the eye after a major surgery. This again will take 1-2 months to resolve. So, at present she will have blurred vision due to the edema and the gas in the eye. I would advise you not to worry about her vision 11 days after vitrectomy. It is a little early to determine her vision potential at present.
Customer: replied 7 years ago.
gas used was C3F8 - bubble was 60% of original at 3 days post-op and 30% at one week. Hole still visible. Intraocular pressure at 24 from previus baseline of 18 (16 day one post-op). For past 2 days there seems to be some dark debris in the bubble (? could this be a clot). Our concern is that the hole may not close since little change and bubble getting smaller a bit quicker than average. OCT planned in 3 days to follow up.
Thanks for the information.
The debris in the bubble is most probably inflammatory cells or few blood cells that can be normally present after vitrectomy. The bubble absorption does not seem to be very quick. The initial C3F8 does get absorbed faster. When the gas bubble gets small then it usually takes longer to absorb. If the gas bubble is very small and the OCT is being planned, then the pressure effect of C3F8 is not much at present. The intraocular pressure will most probaby reduce to normal in the next few days. The initial rise is again due to the effect of the gas and the inflammation.
There is a possibility that the hole might not have closed if an OCT is being planned after 15 days of surgery. This can happen with full thickness macular holes. This is a tough surgery and the success rate depends on the stage of the hole. A partial thickness hole responds better than a full thickness hole. I can understand your apprehension. The exact position will be lea only after the OCT. Till then it woud be ideal to keep the face down position to hasten the closure of the hole.
Customer: replied 7 years ago.

thank you - this makes sense. The retinal fellow thought that the decline in the gas bubble so quickly was unusual but in her limited experience. Two attending MD's did not think it uncharacteristic.

With regards ***** ***** hole, the characteristics of the scotoma have changed. Central core appears to have a more stellate appearance with fine rays surrounding the hole. Previously it had more the appearance of a pupil surrounded by the iris. Might this indicate a partial closure?

This was a Grade 4 full thickness hole, idiopathic, in a 48 year old physician (fetal ultrasound medicine) with myopic index of -6.75 as well as 7 diopter base out prism for a left 6th nerve palsy resulting in diplopia. The macular hole is in the right eye.

If the appearance of the scotoma is varying then there is a possibility that the hole might be in the process of closing. But again the satellite appearence might be due to the edema also. As I said the exact picture will be more clear after the OCT.
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Customer: replied 7 years ago.
Thank you - your advice has been reassuring
glad to be of help.