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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11274
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I have a macular hole in my eye. Monday I am having catarac

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I have a macular hole in my eye. Monday I am having catarac (sp?) surgery, which doesn't bother me. But to fix the hole in my eye sounds pretty scary. Apparently they (inject?) a gas bubble into the eye and you have to lay flat on your stomach for a week. Is this a very common surgery? Are there any dangers? What is the success rate? How unstable is that gas bubble? If you move wrong, it will be misplaced? I have not yet seen the retina specialist. These are the things my regular eye doctor told me. The vision in that eye is 20/400. What cn I expect after the surgery?
Submitted: 5 years ago.
Category: Eye
Expert:  Dr. Rick replied 5 years ago.

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Expert:  Dr. Rick replied 5 years ago.
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Expert:  Dr. Rick replied 5 years ago.

The surgery to address a macular hole is very delicate. One of the reasons you might be having the cataract removed first is to allow your retina surgeon a good enough view of your retina to complete this very delicate surgery.

As a retina specialist I frequently perform this procedure. It is true that after the gel inside your eye (vitreous) is removed, any residual membrane peeled off the surface of your macula and the hole is sealed (there are different ways to accomplish this task) a gas/fluid exchange is done. This leaves a "bubble" of gas inside your eye. There are a couple of different types and concentrations of gas that can be used, some last a few days and some a few weeks.

You are correct about positioning after surgery. It is important that the bubble press against your macula during the healing process. To achieve this, face down positioning is necessary for a period (variable) of time. There are medical equipment rental places where you can obtain special aids to assist you with this. I am sure your retina surgeon will have contact information for rental companies near you.

The bubble, especially early after the surgery when the vitreous cavity is as full of gas as possible, is fairly stable so you really don't have to worry that every little movement will displace the bubble. However, I can not stress enough the importance of post-operative positioning in the successful outcome of your macular hole surgery.

There is really no way to know what your post-operative vision will be at this point. The length that the hole has been present, the stage of the hole (see below) and morphological finding on exam all give some indication on final outcome, however only to the extent of "might be good outcome, may be bad" Picking a probable post-op vision, like 20/20 or 20/60 really is very difficult to do.

Here is an excellent webpage on this topic from a highly trusted source: hole/macular hole.asp

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Expert:  Dr. Rick replied 5 years ago.
I see you have not reviewed my response. Please let me know if there is anything else I can do for you. Best of luck on your upcoming surgery.