Hole in "eye"

[LindaRock]

Dear Doctor,

I had cataract surgery inmy left eye in  April, 2008. After surgery, my eye was qute blurry and I could barely see the "E" on the eye chart the next morning.  I had a scheduled appointment 4 days later and was continuing eye drops, Nevanac and Omnipred, four times a day.  I was told I had "a thickening of the Macular".  Over the next few months, eyesight gradually improved but vision was still "blurry".  It is now four months later and today, I had an appointment with a retinal specialist.  After examination, he detected a "hole" in my eye (macular).  He talked about an operation to correct the vision, stating that there are risks.  I seem to recall that he said that the operation is 90% successful, but of that percentage, only 47% have improved vision.  That did not sound too promising.  He also said that it is important to operatie within 6 months of the cataract operation.  The alterative is to live with the condition.  

After I left the Dr.'s office , a little stunned, I started to think of several questions I should have asked.  

1.  Was the "hole" there before the cataract operation(Should the Dr. have known this?)

2.  What is the relation between thickening of the macular and the "hole"

3..  Did the cataract operation exacerbate the condition of the "hole"

4.  Does the "hole" close on its own?

I am not blaming the Dr. for this condition.  I know there are risks.....I just need some more answers.  I saw your website and this is on my mind....so, I decided to ask your opinion.

[Michael J Kutryb, MD]

The hole was there before the surgery most probably.  The thickening is due to the hole.  The hole will NOT close on its own.  The cataract surgery does not affect the hole one way or the other.  You just won't see well after surgery.  I do an OCT scan all my cataract surgery patients to identify things like this before surgery just for this exact situation that causes the patient to become very frustrated.  If you knew about it before it would all be expected.

MJK MD

[LindaRock]

Thank you for your comments   They make a lot of sense.  I don't want to go through surgery....it sounds risk.  Will the hole get larger over time?  Linda

[Sandy Feldman, MD, MS]

Dear LindaRock

I would become more knowledgeable about the benefits and risks of not doing surgery for a macular hole vs undergoing a procedure.  A macular hole is a break in the retina in one’s central vision.  Depending upon the stage of the hole, progression can occur 50-70% of the time.  

Thus, I would ask your doctor questions about the stage, progression if left untreated, and likelihood if surgery is done for improvement of vision.  He will be able to guide you.

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[rollphil]

I had a macular hole about 3 years ago and immediately had the surgery.  My eyesight improved 90% and I can read with that eye some very small print.  I have certainly never regretted having the operation.  The worse part is you have to hold your head down for 2 to 3 weeks after the operation but it is a small price to pay for having your eye sight.

[LindaRock]

Thanks for your advice.  If I decide to go through with the surgery for a macular hole, my doc said that I would have to hold my head down for 10 days.  Can you at least walk with your head down....or, do other activities with you head down?  I am an active person, and just can't imagine lying down for 10 days!  Must the surgery be done within 6 months of the cataract operation.....is it effective if I wait longer?  Linda

[gigs924]

I had vitrectomy for macular hole the first of this year and cannot read anything with that eye.  Thank goodness my other eye is good.  My retinal surgeon has no idea what is wrong.  Choose your surgeon CAREFULLY.