While surgery for retinal detachment is very successful, there may be a few rare complications that can occur. Among the complications that can occur are recurrence of retinal detachment, scar tissue forming on the macula (epiretinal membrane), high eye pressure, and infection.
Macular Hole is Uncommon Complication
One of my patients recently developed a macular hole soon after a successful retinal detachment operation. This is the second time that I have come across this complication. The macular hole was not observed during the procedure and was only noticed 2 weeks after surgery. It turns out that this rare complication occurs in less than 0.5% of eyes after vitrectomy surgery (as reported by my Korean colleagues in a recent scientific article).
Many Diseases Affect the Macula
The macula is the most sensitive part of our retina. It has the highest concentration of nerve cells and is responsible for our ability to see sharp details and colour. It is very easily damaged by various diseases like AMD and diabetic retinopathy. As it is the thinnest part of the retina, holes can also occur there. Macular holes are caused by the vitreous gel pulling on the macula. Scar tissue around the macula can also cause holes to occur.
Surgical Repair for Macular Holes
Macular holes can only be treated with surgery. An essential surgical step is to peel off the innermost layer of the retina called the ILM. This is a very difficult surgical procedure but is essential to ensure the complete closure of the hole. By peeling away the ILM, the retina tissue at the macula is less stretched and can come together to close the hole. I also put a gas bubble in the eye at the end of surgery and instruct my patients to sleep with their face facing down for one night after surgery.
The gas bubble will help close the macular hole. Many surgeons have different posturing regimes after macular hole surgery and I don’t think that you need to sleep face down for more than 1 night and I tell my patients to just avoid sleeping on their back for 1 week after surgery. This ensures that the gas bubble is always in contact with the macula.
My patient had a second operation to fix the macular hole and to mine and her relief, the hole has closed up and she can see well again!