cataract surgery first before macular hole surgery?

I am extremely myopic (my doctor says I have pathological myopia in both eyes).  My left eye has a pretty bad macular hole and I also have severe cataracts in the left eye (on the scale of 1 - 4, mine is a 3).  I've been to two retinal specialists, one who said that I should have the cataract surgery first and then have the retinal surgery to repair the hole, 2 weeks later.  The other said that she would do the retinal surgery first.  I am reluctant to have the retinal surgery at all, thinking that I might just live with the macular hole.  However, I was thinking that having the cataract surgery might help improve my vision, even by just a little bit.  My cataract surgeon told me it would be useless, the improvement being only so slight that I would hardly notice the difference.  He also said that because I am so severely myopic, the cataract surgery would increase the likelihood of future retinal detachments and might even worsen the macular hole or create some new retinal problems.  Why do cataract surgery for such small returns?  He will only do the cataract surgery if I agree to follow it up with retinal surgery.  What do you think?


This discussion is related to macular hole repair success rate.

[Ray T Oyakawa, MD]

You need a good view to do the macular hole surgery.  It sounds like the cataract is severe enough to limit the view during macular hole surgery.  I would have the macular hole surgery after the cataract surgery.  Also, cataract surgery is harder after a pars plana vitrectomy for macular hole surgery since the vitreous is removed and there is less support for the cataract during its removal.

Dr. O.