Treatment Alternatives
Vitrectomy for Macular Hole
This surgical procedure involves removal of the vitreous, replacing it with a type of gas bubble.
After surgery, the gas bubble will cause severely limited vision in the operated eye for at least a
few weeks and maybe a few months. Eventually, the body will absorb the bubble and replace it with
natural eye fluids.
Although vitrectomy is 80 to 90 percent effective for the treatment of a macular hole, it does not
work for everyone. Some patients may need more than one operation. Success is enhanced if the patient
can maintain a face-down position at all possible times after surgery, for at least a week. Our
department has tips on how this position can be maintained as comfortably as possible.
The benefit of surgery to repair a macular hole is hard to predict. Some patients notice a prompt,
significant improvement in their vision. Others may experience only a minimal improvement. A "fresh"
hole is often easier to successfully treat than one that has been longstanding. For greater that 6
months.
As with any type of surgery, there are risks for associated with surgery to repair a macular hole.
Complications are infrequent, but do occur and include serious problems like retinal detachment,
hemorrhage and infection. These complications could cause a severe loss of vision. Persons who have
had macular hole repair are at increased risk for developing a cataract.
Macular hole surgery can be done under local or general anesthesia and usually requires an overnight
stay in the hospital. There is little pain or discomfort involved although some patients will have
difficulty maintaining the face-down position.
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Laser Photocoagulation for nonproliferative diabetic retinopathy
A laser is a device that delivers a split-second burst of light. Before the treatment begins, the
patient is seated in front of the laser. After the eye is numbed by anesthetic drops, a contact lens
is placed on the eye, and the laser beam is focused through it. It may also be delivered through the
indirect ophthalmoscope with the patient reclining and without contact lens.
In some cases, the ophthalmologist will refer to the photographs from the fluorescein angiogram to
identify areas to be treated.
A burst of light is visible for a fraction of a second. When the laser's light is absorbed by blood
and pigment in the back of the eye, it is converted to heat, which coagulates leaky blood vessels and
forms laser marks in the retina.
Studies sponsored by the National Eye Institute and performed at institutions around the country,
including Wills Eye Hospital, have proven that photocoagulation is beneficial in eyes with
nonproliferative diabetic retinopathy and macular edema and that it decreases the risk of moderate
vision loss by almost two-thirds.
Laser photocoagulation is not appropriate for everyone with leaking vessels, and researchers continue
to look for new and better ways to treat persons with nonproliferative diabetic retinopathy, such as
injections of steroids into the eye.
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Laser for Proliferative Diabetic Retinopathy (PDR)
Laser is also helpful for proliferative retinopathy, in which new blood vessels (neovascularizations)
grow on the surface of the retina. These neovascularizations can break and bleed into the vitreous,
leading to serious vision problems, such as retinal detachments. Laser treatment for proliferative
diabetic retinopathy can reduce blood vessel growth and decrease the risk of retinal detachment by
eliminating the abnormal new vessels.
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Vitrectomy in Diabetic Retinopathy
When a vitreous hemorrhage is dense enough to cause significant blurring, a vitrectomy may be
necessary. In this surgical procedure, surgeons use a high-powered microscope to see inside the eye
and to insert small instruments that will remove both the vitreous and the hemorrhage. The vitreous
is replaced with a clear water solution.
After the surgery, some patients will notice a significant improvement in vision. However, in about 20
percent of cases, patients may develop another hemorrhage. Because of this and the possibility of
other complications, the ophthalmologist might recommend waiting for up to three months for the
hemorrhage to clear before proceeding with another vitrectomy.
If the retina becomes detached, however, a prompt vitrectomy mayt be necessary in an attempt to remove
retinal scar tissue and to preserve vision.
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