Saturday, September 27, 2008

Reader Questions and Suggestions

Hi Kelly;
I have been referred to a vitreoretinal surgeon for a macular hole in
my left eye. However, I have this strong feeling that I have it in my
right eye as well. (I was diagnosed with macular puckers in both eyes
earlier this year). The vision problems in each eye are different --
left eye is blurry central vision spot; right eye is difficulty
focusing and what appears to be a "central floater".

I see a surgeon next Friday, but am curious. When both eyes are
involved, is surgery generally performed on both eyes at the same time,
or are they typically done at different times? Just curious. This
waiting to see the surgeon next week is difficult.


Hi Linda:

Vitrectomy surgery is done one eye at a time. The risk of post
operative infection is very, very small but if infection occurs it can
be devastating. It would be difficult to contain an infection to one
eye therefore, the benefits of doing a bilateral surgery, if there are
any, are far and away outweighed by the risks.

Linda, this is a very good question and one in which others may be
interested. May I post your question on my blog: ?

Toni Kelly


  1. Hi Toni;
    Thanks for your response. And, yes, you may post the question on your
    blog. I had read your blog, and being new to the blogosphere, I wasn't
    sure how to post my own question without it appearing as a response to
    someone else's question/answer.

    Now I have another couple question:

    I think I have read everything I can find on macular holes and surgery.
    The statement from the website of the doctor I am seeing (who happens to
    be a cousin of my coworker! Small world) is:

    "There continues to be great variability among surgeons in the
    requirements for face down positioning, though the general tendency
    has been to decrease the required duration. Today, most surgeons
    require face down positioning for approximately 1 week. However,
    surgeons at VRS have found most macular holes can be successfully
    sealed using new surgical techniques with very little or no face
    down positioning. Your surgeon will advise you what the requirement
    will be for face down positioning in your particular case."

    This is the only place I have seen the possible no face down
    positioning. Is that generally with the use of an oil tamponade? The
    NIH website says face down positioning for 24-48 hours or as long as 3
    weeks, I think. Is this the trend?

    What about glasses prescriptions in the "healing" time period? Does one
    need to change prescriptions regularly, or wait until the vision has
    improved? How does the old prescription work in the mean time? This is
    another cost I need to figure in this equation.

    Again, I will find out more next Friday (which can't come soon enough),
    but just curious. I have a list of questions a mile long. You can feel
    free to post these questions as well. Thanks for your assistance! Linda

    Hi Linda:

    Great questions. Good for you on being an informed patient. I hope your surgeon recognizes your need to know and answers all your questions fully.

    Regarding the length of face down positioning required following vitrectomy surgery; as is stated on your surgeon's website, there are different opinions on the subject. The vast majority of retinal surgeons request up to a week of full time positioning, but there are several surgeons asking for more, several for less, more like three days, and a few who don't require any positioning at all for some patients. It is important to remember each individual case is different and the same surgeon may require different post op compliance from two separate cases, just as your surgeon's website said.

    Then there is the use of silicone oil. Positioning seems less stringent, but it does not seem to gaining much favor for macular hole repair. The main downfall of using oil instead of gas is that you have to go back in and remove the oil, requiring a second surgery. I certainly welcome any comments on this subject by knowledgeable sources or by those who have had the procedure on the blog.

    Finally, glasses will be of no value to the surgical eye while the bubble is in the way of vision but you may want to be sure the non operative eye prescription is giving you adequate vision. If you are seeing well with your current pair you will probably just wait until you are fully healed before you look into the possibility of a new prescription. If you have not had cataract surgery already then you need to know that it is very likely you will need it not very long after your vitrectomy. Cataract surgery will likely change your prescription somewhat.

    Toni Kelly

  2. I am seven weeks after my surgery. My bubble just disolved today. It went fast after is was small. My question is about my vision. The vision in that eye is still very blurry, both with my glasses and without. How long does it take to improve? My vision is better than before the surgery, the bends are gone, but its very blurry. My doctor just says it takes some people more time than others. After my surgery, I just laid face down at the end of the bed and put our laptop there with lcd monitor connected, and I could play games, watch movies, etc. This helped considerably.

  3. I am afraid there are just too many variables to give you a good specific answer. Many things contribute to quality of vision after macular hole repair. You mention the bends are gone, which is a good sign that the hole is closed. Your vision may be affected by a growing cataract; there is a high incidence of escalated cataract growth after macular hole repair. Ultimate vision may be affected by how long you had the hole, and how large it was. Your doctor is the best resource for the answer to your specific case. It is probably worth noting here that surgical success may be measured more by complete hole closure than by post operative vision assessment.

  4. Hi everyone, the name here is John. as of the last three years i har two macular hole surgeries same eye, the results were good both times, in fact my last surgery was 8 weeks ago, i still have a small gas bubble, i kept my head down 10 days, doctor said i could look up 5 to ten min. / hr, to help looking down i designed and built a chin - arms rest which i carried around with me and used while sitting, could watch t v listen to radio talk , music,, i came up with many ideas to do while looking down, all planned prior to surgery,, and it helped, good planning will help the days go by, i would be more than glad to help anyone with sugestions, John Curea Boardman Ohio

  5. John: Call me 1-800-721-8172. Maybe your invention can help others!


  6. Any input or opinion on outcomes for a 50 yr old severely myopic patient (minus 17 eye prescription) needing vitreotomy for a MH? Any comments or opinion on whether to proceed with vitreotomy while a hole is developing, or wait to until an actual hole does occur? If you have a MH in one eye, is it more likely other issues will occur with other eye?

    Thanks for all the time, support and good work for people in need.

  7. I had a vitrectomy on June 2nd. to correct a macular hole in the left eye. My surgeon instructed me to assume the face down posture for 24 hours the first 3 days. Then 12 hours daily for the first full week, then 8 hours daily for the 2nd week, and 4 hours total for the 3rd. week. My macular hole healed in 10 days according to the doctor after his examination. Once I got through the 8 hour daily procedure I felt the rest was a piece of cake. I was able to pass the long hard hours face down by lying on the bed's edge reading a book elevated by a foot stool. I also was able to watch movies on my computer as well with the laptop on the floor by the bed. I was able to do light exercise riding a stationary bike in the face down position. It has been 7 weeks since the surgery and the bubble is almost gone. I am cleared to fly and to resume normal activities. My advice for all, be sure you adhere to the face down rules to ensure total success. Good luck to all...

  8. My sister in law is going to have this procedure and we live in mexico and they do not have rental equipment. Any suggestion as to how to beat the frustration of being in posture for one week or more? any tips as to what to use - such as anonymous just posted above - book on a foot stool..