Macular Holes and Epiretinal Membranes

Macular Hole

Two decades ago, macular hole surgery was not very successful. At PRIME we grew together with the successful results of macula hole modern surgery. Nowadays macular hole is a very treatable disorder. We start macular hole repair with removing the jelly that is pulling on the retina/macula with a sutureless small gauge vitrectomy. A delicate membrane (the ILM or internal limiting membrane) situated around the hole which keeps it open is peeled away and a bubble of gas is placed on the macula to close the hole. The whole treatment takes approximately 30 minutes under local anesthesia, without staying at the hospital.

The bubble of gas used at the end of vitrectomy surgery to press the retina against the wall of the eye, remains in place for 7-14 days. The patient is postured for two to three days because the macula is at the back of the eye so the patient lies face down causing the bubble to rise to the where the macula is located.


Epiretinal membranes

Surgery for this condition involves vitrectomy with epiretinal membrane peeling. The relaxed retina drains and return to its normal position. It might take a few weeks to months to notice the difference. We often combine the surgery with cataract operation, especially when the patient is over 50 years of old. The peeling of the membranes is done by staining the membrane with nontoxic dyes. The results are rewarding.


Vitreomacular traction (VMT)

New treatment indicates an injection of Jetrea (ocriplasmin) for a small proportion of cases. Upon injection of this drug, breakdown of the vitreous jelly occurs meaning that it separates the collagen, releasing the VMT and the macula falls back into place.
Jetrea is a newly approved drug and time will tell whether the drug is as good as claimed by the manufacturers.
For the vast majority of the cases, vitrectomy with VMT release, similar to epiretinal membrane peeling is performed.

As with all surgery there are risks. With eye surgery, the infection risk is around one in 1000. Cataract formation due to the bubble of gas used during surgery is also a risk, and for this reason cataract surgery might be required at a later date or simultaneously. We lead the way in combined cataract and vitrectomy treatment since 2003.

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