Macular Holes: Risks, Surgery, and Vision Recovery

Q: Macular Holes: Risks, Surgery, and Vision Recovery

Hello： <br>1. <br>For macular hole, continued enlargement may lead to further loss of retinal tissue. <br>The success of surgery and the degree of visual recovery depend on multiple factors, including the size, location, and morphology of the hole, as well as the postoperative re

Macular hole

Hello Doctor, I would like to follow up on the issue mentioned in article #207477: Last September, vitreous degeneration caused traction on the macula, resulting in a hole (which is currently likely a macular lamellar hole).
In November, the vitreous spontaneously detached in the center, but during follow-up visits in February and April, the hole on the right side has been enlarging due to ongoing traction from the vitreous.
At Hospital A, my visual acuity was measured at 0.5 (the prescription of my old glasses is insufficient), but at the optical shop, it was corrected to 1.0.
However, I notice a defect in the upper right corner of my vision, and small text or distant objects appear distorted.
The doctor mentioned that the visual acuity test might have intentionally avoided focusing on the defect.
Although the hole has enlarged during these two follow-up visits, my vision has improved slightly, and the degree of distortion has remained relatively the same.
I have a few questions for the doctor:
1.
I am concerned that the hole may continue to enlarge (currently likely a lamellar hole).
Will this lead to further loss of retinal tissue that cannot be repaired after surgery? If I wait until my vision deteriorates significantly or the hole becomes very large before undergoing surgery, will the recovery of my vision be poor and the distortion more severe post-surgery?
2.
Given my high myopia of 800 degrees, will this affect the success rate of the hole repair surgery and result in poorer visual recovery? (Although my vision can currently be corrected to 0.9, would it be more beneficial for me to have the surgery sooner to prevent further vitreous traction and enlargement of the hole?)
3.
Doctor A mentioned the potential issue of tissue loss; however, Doctor B believes that my current vision (with the old glasses not updated) measured at 0.8 (Hospital A measured 0.5) should be observed first.
Doctor B also mentioned that if surgery is performed now, I may still face issues related to high myopia, such as unilateral cataracts and other complications post-surgery, which may not necessarily be better.
However, I am worried about the issues raised in points 1 and 2.
I would like to seek your advice on this matter.
Thank you!

bu fang bian, 30~39 year old female. Ask Date: 2024/05/11

Dr. Gao Pilin reply Ophthalmology

Hello:
1.
For macular hole, continued enlargement may lead to further loss of retinal tissue.
The success of surgery and the degree of visual recovery depend on multiple factors, including the size, location, and morphology of the hole, as well as the postoperative recovery.
Generally, if the hole is larger or symptoms are more pronounced, early surgery may help prevent further retinal damage, but visual recovery after surgery is not guaranteed.
A retinal specialist will assess your individual situation to determine the most appropriate treatment plan.
2.
High myopia may increase the risk of complications after hole surgery, but it does not necessarily mean that visual recovery will be worse.
The success of the surgery depends on the condition of the eye and the complexity of the surgical procedure.
A retinal specialist will provide the most suitable treatment recommendations after evaluating your condition.
3.
Different physicians may have varying opinions, which is normal.
It is important to consider your eye condition, the severity of symptoms, and the risks and benefits of surgery comprehensively, and to make a decision after an in-depth discussion with your retinal specialist.
If you have concerns about the surgery, you can consult your physician for more information and collaboratively develop a treatment plan that suits you.

In summary, it is advisable to have further discussions with your retinal specialist to determine the most appropriate treatment plan for you.
Wishing you a speedy recovery!

Reply Date: 2024/05/11

More Info

Understanding macular holes, particularly in the context of your situation, involves a multifaceted approach that considers the risks associated with the condition, the surgical options available, and the potential for vision recovery post-surgery.

1. Risks of Macular Holes and Vision Loss
Macular holes occur when there is a break in the macula, the central part of the retina responsible for sharp vision. As you mentioned, the ongoing vitreous traction can exacerbate the condition, leading to an increase in the size of the hole. If the hole continues to enlarge, it can lead to more significant retinal tissue loss, which may not be repairable through surgery. The longer the hole remains untreated, the greater the risk of permanent vision loss.
In your case, since you have already experienced some vision distortion and loss, it is crucial to monitor the progression of the hole closely. If you wait until your vision deteriorates significantly before opting for surgery, the chances of a successful outcome may diminish. Studies indicate that earlier intervention often leads to better visual outcomes, as the retina may still retain more functional tissue that can be salvaged.

2. Surgical Options and Success Rates
Surgery for macular holes typically involves a procedure called vitrectomy, where the vitreous gel is removed to relieve traction on the retina, followed by the insertion of a gas bubble to help close the hole. The success rate of this surgery can be influenced by several factors, including the size and duration of the hole, the presence of other retinal conditions, and the overall health of the retina.

Your high degree of myopia (800 diopters) can complicate the situation. High myopia is associated with a higher risk of retinal complications, including macular holes and retinal detachment. While myopia itself does not directly affect the success rate of macular hole surgery, it can influence the overall health of the retina and the likelihood of other issues arising post-surgery. Therefore, it is essential to weigh the risks and benefits of surgery carefully.

3. Timing of Surgery
Given your current visual acuity of 0.9 and the fact that you are experiencing some distortion, it may be beneficial to consider surgery sooner rather than later. Early intervention could prevent further deterioration of your vision and potentially improve your visual outcome. However, the decision should also take into account the opinions of your healthcare providers.
Dr. A's concerns about tissue loss and the potential for poor outcomes with delayed surgery are valid. On the other hand, Dr. B's perspective suggests a more conservative approach, considering your current vision and the possibility of other complications arising from surgery. It is essential to have a thorough discussion with both doctors about your specific case, including the potential risks of waiting versus the risks associated with surgery.

Conclusion
In summary, the decision to proceed with surgery for a macular hole should be based on a careful assessment of the risks of vision loss, the potential benefits of early intervention, and the overall health of your retina. Given your high myopia and the ongoing changes in your vision, it may be prudent to consider surgery sooner rather than later to maximize your chances of a favorable outcome. Always ensure that you have open communication with your healthcare providers to address your concerns and make an informed decision that aligns with your visual goals and overall health.

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