possible unsucessful macular hole surgery

My mother was missed diagnoses with macular degeneration, she actually had a macular hole. As such she did not know she had the option of having surgery to fill the hole and the hole was large when she finally did find out she had a macular hole and could surgery. She had surgery on June 7, 2007 and was told to lay face down for 7 days. She layed face down for the 7 days however, opon returning for her post-op on today June 14, 2007 she was informed that the hole did not close. She still has the bubble (she had the gas bubble) in her eye and still is not seeing very well. The doctor has since refered her to another surgeon for consultation. Has anyone had any experience with the hole not closing suceessfully after the 7 days but then going on to close? I guess I am wishing/praying that there is still hope that the hole may still seal. Although the doctor said he would know in 7 days if the operation was successful or not. Appreciate any feed back.

[John C Hagan III, MD, FACS, FAAO]

The diagnosis of macular hole was not necessarily missed. Your mother may have macular degeneration AND have had a macular hole develop later. There are other types of macular degeneration than age related macular degeneration and some of them not infrequently develop macular holes.  Without getting too technical some apparent holes are really 'pseudo-holes' and do not require surgery. Some, but not all, of pseudo-holes will later develop into true full retinal thickness holes.

Not all true retinal holes need closure surgery. If the hole is small, located off the center of the macula, if severe medical problems make the surgery too risky, or the vision is good, observation is often the best course of action.  

Macular hole surgery is major eye surgery and often requires very physically and emotionally draining positioning after the closure if a gas instilled in the eye.

Standard risks of this type of surgery include inability to close the macular hole. Also the hole may be closed but the vision may not improve. Even with hole closure the vision frequently does not return to normal.

There is always hope that the hole will close in the future but your best course of action is to review the prognosis of further observation vs repeat procedure with your retinal ophthalmologist and the consultant that is giving a second opinion.

Good luck.

JCH MD

[wealthworthy]

Thanks for your feedback. My mother had gotten a second opion before opting for surgery to close the hole. The surgeon that performed the surgery recommended she consult with the third surgeon for recommendation as to what to do next. Her vision was inpaired prior to the surgery and the hole had gotten worse since her first visit with the surgeon that performed the surgery to close the hole.

I was just hoping that although the doctor stated if the surgery was successful the hole would have closed in 7 days that it still just may close.

Thanks again.

[vancouver604]

I had surgery to repair a hole in the macular of my left eye almost 3 months ago and was in a face down position for 3 weeks. The gas bubble took exactly 62 days to disappear altogether. The vision of that eye hasn't returned to what it was prior and it may never will. However, I am thankful that I can still see.So tell your mother to hang in there. It is a slow process.