FAQs- Macular hole surgery
1) Will I need to lie face down after the surgery?
No- this is no longer done. We use the gas to keep the macular hole dry for the first few days after surgery. This is so that the hole can close.Being propped and looking straight ahead or down is adequate.
2)How soon will I know if the hole has closed?
We always use gas at the end of the procedure. We cannot tell if the hole is closed until the gas is at least halfway reabsorbed. This is a minimum of 7-10
days after the surgery.
3) What will my vision be like after the hole has closed?
Once a macular hole has formed, there is always longterm change to your vision. What you can expect is a gradual decrease in the size of the central blur as well as a decrease in how dark the blur is. This can improve for up to a year post-op.
1) How soon will I be able to see again?
This is a complex question. At the end of the surgery your eye will be filled with gas. Depending on the type, it will take 2-8 weeks to be completely re-absorbed. Once it is halfway reabsorbed, your vision will be clearer. If your macula detached pre-operatively your macula will improve function over the next 9-12 months.
2) Will my eye see as well as if did before the detachment?
This depends on a number of factors. A detachment is a blinding condition and the surgery does very well to prevent this from happening. If your macula has detached, your vision will be diminished by varying degrees depending on how long the macula has been detached for. However your macular function (and your vision) can improve over the next few months. If you have not had prior cataract surgery, the gas used at the end of surgery tends to cause cataract sooner or later and that will need to be rectified at a later date.
3) Can the eye re-detach and what risk is there to my other eye?
Detachment surgery is much improved from what it used to be. Our success rate is in the region of 90% with one surgery. We monitor your eye in the post-op phase to ensure that the retina is in place. Once the gas is gone completely we will know that the surgery was successful. There is a very outside chance that the eye will re-detach after the gas has gone and the risk diminishes as time goes by. Your fellow eye will be examined to exclude any retinal tears and predisposing retinal weaknesses. These will be lasered if present. The most important protection for your fellow eye is awareness of any retinal symptoms in the fellow eye i.e flashing lights and new floaters. If this occurs, you must seek help immediately. If we pick up a retinal tear prior to the retina detaching, we can laser the tear and avoid surgery.
1) Am I going blind?
No- your central vision only is affected by this process. People are also affected to variable degrees. However macular degeneration can damage your functional vision i.e. reading and driving vision. With that said we are able to maintain vision in the majority of people with many years.
2) Can I ever stop injections?
No- not with current treatment. The aim of the injection is to get the macula dry. We usually do 3 injections one month apart. After the loading phase we can then extend the interval between injections, but only as long as the macula remains dry. This is called treat and extend. Each time we see you and the macula is dry , we extend the interval by 2 weeks up to a maximum of 16 weeks. Average interval is 8 weeks down the line.
3) What can I do to protect my eyes?
You can do all your usual tasks. If you smoke you should seriously quit. It is your most significant modifiable risk factor. Also do not be a victim of passive-smoking. If you have children who smoke, educate them of their risk of developing AMD and encourage them to quit. Dies is important- antioxidants and AREDs multivitamins are of benefit
4) Is there any treatment for dry AMD?
Unfortunately not. The progression of dry AMD is not modifiable at this stage. There is a lot of research being done but at this stage there is no known treatment.
1 ) Will I feel pain if I have local anaesthetic during the surgery?
No- you will feel no pain. If you have an injection next to the eye, the eye becomes completely numb and the vision in that eye reduced. You will not see anything either as you other eye will be covered under a drape. Cataract surgery is usually essentially painless and well-tolerated. Modern technology is fantastic in this regard. If you have topical anaesthetic you will be comfortable and relaxed but aware of light and movement. You will need to keep your eye still and focus on the microscope light
2) Will my medical aid cover surgery if it is done as a day case?
Yes- you are admitted as a day case and it is an in-hospital procedure.
3) Can both eyes be done on the same day?
No- for a number of reasons. The most important of which is making sure that the first eye has healed and has no issues prior to embarking on surgery for the fellow eye. We usually do the second eye in 1-2 weeks, depending on your preferences and availability of your transport
4) Will I be spectacle free?
Your dependence on spectacles will be very much diminished. If you have specifc requests with regards visual needs this will be discussed at the room consult.
Corneal cross linking
1) How successful is the procedure?
The aim of CXL is the arrest the progress of the keratoconus. The success rate to this end is around 90%. It is critical however to remember that no form of eyelid rubbing is allowed, as this worsens keratoconus. 70-75% of people experience an improvement in their vision in that the cornea flattens.
2) Will I need glasses or contact lenses after the procedure?
This depends on the degree of pre-procedure keratoconus present, as well as the amount of flattening that takes place post-procedure.
2.1)When will we know if the procedure is a success?
The cornea usually swells for the first 6 weeks after the procedure. During this time your vision will be reduced. The cornea then slowly starts stabilising and we shoufl start seeing an improvement after 6 months
3) How long does the effect of the CXL last?
Corneal collagen lasts around 5 years so the effect of the cross-linking should be 5 years. However we need to do followup corneal scans twice a year to be sure that there is no deterioration. Should the cornea show signs of steepening again the CXL can be repeated.
4) Does medical aid cover CXL?
Und=fortunately this is not a simple answer. They definitely all should as it is the only procedure that can stop the progression of keratoconus. We will assist in motivating to your medical aid and try and get as much paid for as possible. Medical aid coverage for this procedure changes all the time.
1) How soon will my vision recover?
ERMs are layers of scar tissue which have to be peeled off the retina. The peeling itself will increase the macular swelling in the short-term. As your retina is central nervous system tissue, it takes time to recover. If we have to use a gas tamponade on your eye, you will not see much until the gas is half-way reabsorbed. Full recovery takes 6-9 months.
2) How do you get into the back of the eye?
We use small self-sealing incisions a few millimetres back from the edge of your cornea. We use 3 access sites one of which is a light; the other an infusion and the other a vitreous cutter. There is then a specific viewing system attached to the microscope with a lens above the eye . This allows us a wide-angled view of the back of the eye where we are working.
3) Do you take the eye out?
That is seriously the most asked question! No- we open the eye wide with a speculum and use the viewing system described above.
4) Do you always use gas?
No- only if there is a retinal tear. This is something we would see and treat during surgery. If this occurs, you will need to posture to keep the gas bubble on the hole. In a worst case scenario you may need to lie on your side for 5 days. This would only be if the tear is in the lower part of the retina.