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1. Overview

2. The gas bubble

3. How does the bubble affect vision?

4. Head positioning

5. What to expect

6. When does the vision improve?

7. Postoperative instructions

8. Postoperative medication

9. Frequently asked questions

10. How do I get more information?

Overview

Macular hole surgery is unique because the outcome is not only dependent on the surgeon's skill, it requires the commitment of the patient afterward. 

The gas bubble

During surgery, a gas bubble is placed inside the eye. The bubble puts gentle pressure on the macula and helps the hole to seal. In order to enjoy the benefit of the surgery, it is imperative that the bubble floats against the macula during the critical healing phase. Since the gas rises, this is only possible when the head is in a face-down position. Obviously, it is impossible to remain face-down 100% of the time; however, each moment spent in this position increases the likelihood of successful surgery. 
 

How does the bubble affect vision?

When the bubble is first injected, it nearly fills the eye. This obstructs vision for the first few weeks following surgery. Over time, the bubble gradually dissolves, and vision improves. As the bubble gets smaller, it sometimes breaks up into several smaller bubbles. This is common and does not pose a problem. The outcome of the surgery cannot be determined until the bubble begins to disappear. 

Head positioning

It is important to remain face-down as much as possible for 9-10 days after surgery. While this may seem a bit awkward, there are several things activities that can be done in this position. Many patients read a book or magazine while looking down. The non-operated eye will not suffer from overuse or strain.  

Some patients watch television by placing it face-up on the floor. An alternative is to place a mirror in order to see a reflection of the television screen when looking down. Other activities that can be done while sitting and looking down are perfectly acceptable. 
 
At times, the positioning may be uncomfortable; but a successfully closed hole and improved vision is well worth the temporary aggravation. 

What to expect 

The eye is patched after the first postoperative checkup. This can usually be removed the same evening at bedtime. Since the anesthesia numbs the lids and temporarily prevents blinking, it is very important to keep the eye patch on until you are able to blink the eye normally. Begin using drops after the patch has been removed.  
 
How should the eye feel? 
It is common to experience some discomfort immediately after the surgery and for several days afterward. This is primarily related to swelling on the outside of the eye and around the eye lids. A scratchy feeling or occasional sharp pain is normal.  
Ice compresses gently placed on the swollen areas (ice placed inside a resealable plastic bag work well) reduce the aching and soreness.

If you have a deep ache or throbbing pain that does not respond to Tylenol or other over-the-counter pain medication, please call your doctor. 
 
Redness is common and gradually diminishes over time. Some patients may notice a patch of blood on the outside of the eye. This is similar to bruising on the skin and slowly resolves on its own.

When does the vision improve?

Until the gas bubble has cleared, your vision will be very poor. In some cases, it may take several weeks for the bubble to clear completely. You will notice your vision slowly returning as the bubble clears.  
 
While taking the dilating drop (red cap) the pupil of the operated eye will be quite large and you may be light sensitive. This drop makes more room for the gas bubble by keeping the pupil dilated. It also keeps the eye more comfortable.  

Postoperative Instructions 

Following surgery, patients are examined the same day or the following morning.  
 
1. Keep the eye patched until later in the day when you are able to blink the eye lids normally.
 
2. Begin taking medications as directed after the eye patch has been removed.
 
3. If you experience aching or soreness immediately after surgery, gently place ice compresses on the eye. Tylenol is also helpful for minor aching and soreness. 
 
4. Wear the plastic eye shield when sleeping for the first 7 days after surgery. It should also be worn when showering for the first 3 days after surgery.
 
5. The eye is most susceptible to infection for the first 7 days after surgery. To minimize the risk, avoid touching, rubbing, or bumping the eye.
 
6. Avoid air travel until the gas bubble has completely dissipated from the eye. This is important because the gas expands at high altitudes and could elevate the eye pressure to a dangerous level. Please check with your surgeon to be sure that the bubble is gone before flying.
 
7. Most importantly: Keep your head in a face-down position for 9-10 days following surgery. This can be done while sitting or lying down.  

Postoperative medication

Most patients take three different eye drops after surgery. The eye drops serve several purposes such as: preventing infection, reducing swelling inside the eye, reducing redness, and keeping the eye comfortable. The dilating drop with the red cap keeps the pupil very large and causes light sensitivity. Consult your written instructions for a list of medications and appropriate dosage.  
During your follow-up visits, you will receive instructions how to gradually reduce the frequency of the drops and eventually stop them all together. 

Frequently asked questions

Q: Will I get at least a partial benefit from the surgery if I can't keep my head down?

A: The success of macular hole surgery is largely dependent your ability to keep your head in a face down position. This positions the gas bubble correctly on the macula, where it can maintain constant gentle pressure. This is critical for the hole to seal closed and for your vision to improve. 

Q:  Why do I feel that I'm looking through water?
 
A: This sensation comes from looking through the gas bubble. Your vision may also seem "wavy" from the movement of the bubble inside your eye. 

Q: How soon after surgery will my vision improve?
 
A: Initially after the operation, your vision will be obstructed by the gas bubble. As the bubble slowly dissipates over a period of weeks, you will begin to see an improvement in your vision. Many patients continue to notice a gradual improvement for several months after surgery.

Q: Should I use my eye drops in any particular order?
 
A: The order the drops are used is not significant. However, in order to get the full benefit of the medication, be sure to space the drops at least 5 minutes apart so one doesn't wash out the other.

Q: How can I eat, drink and bathe with my head down?  
 
A: Using a straw is the best way to drink with your head down. Other activities such as eating and bathing should be planned for 5-10 minute breaks that you can take every hour.

How do I get more information?

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