Retinal Degradation & Treatment
The macula is the area of the retina that provides the best vision for
reading and seeing fine detail. A hole in the macula can develop with
age ("idiopathic" macular hole), trauma, and in people who are
severely nearsighted. Idiopathic macular holes are common, usually occurring
in patients over the age of 50. These holes form from pulling by the vitreous
gel on the center of the retina. Macular hole formation occurs in stages
beginning with a cyst (stage 1) and ending with a full thickness hole
with separation of the vitreous gel (stage 4). Reading and detail vision
is ultimately lost.
A vitrectomy may be used to remove the vitreous gel and close the macular
hole. Fine membranes (scar tissue) are peeled from the edge of the hole
and a gas bubble or oil bubble is placed in the eye to help seal the hole
while it heals. When gas is used, the patient must remain face down for
some time after surgery to help seal the hole. If oil is used, it must
be removed in a second operation.
Scar tissue in the area of the retina that provides vision for fine detail
and reading is called macular pucker or epiretinal membrane. Scar tissue
can form in the center of the retina creating distortion and blurring.
When the vision is only mildly affected, observation may be best. With
significant distortion or blurring however, vitreous surgery can be used
to restore vision for the majority of patients. Patients generally recover
half of the vision lost from the macular pucker after surgery. Vision
recovery can take weeks or many months, and as with all surgeries, the
risks, benefits and alternatives must always be considered.
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