Part Two: Factors Contributing to a Successful Outcome After Macular Hole Surgery

By Joy R. Efron, Ed.D.

This is second of a five-part series, Surviving Recovery from Macular Hole Surgery. This section discusses several factors and general precautions that the author found helpful in her recovery.These are things to think about pre-operatively.

I am extremely fortunate. I feel that my successful outcome is due to a highly skilled surgeon and my strict adherence to the regimen of face-down positioning. Remaining face-down throughout my recovery would not have been possible without the assistance of others, face-down positioning equipment, mentoring and encouragement by others who have gone through macular hole surgery, and support of family and friends. Even if you will be doing a shorter period of face-down positioning, there are many aspects of this period of recovery that you’ll want to consider.

A Highly Skilled Surgeon

Make sure you have a highly skilled, experienced retinal surgeon. Ask a lot of questions, including how many vitrectomies and macular hole surgeries the doctor has performed, as well as his or her frequency performing those operations.

Ask about the surgeon’s anatomical success rate, i.e., the percent of holes that close following surgery and the incidence of holes that later reopen. According to the literature, about 90% of holes close following recovery from surgery; about 15% of those reopen.

Ask about the surgeon’s functional success rate, i.e., anticipated improvement in visual acuity. In my research, I was unable to find more than nebulous information, such as “…most patients improve two lines on the Snellen chart…” or “…regain half their vision.”

Cataract surgery on post-macular hole patients can present special challenges for the surgeon. Make sure you have a highly skilled cataract surgeon who has successful experience with post-vitrectomy patients. If you were measured for a cataract replacement lens prior to macular hole surgery, ask if you should be measured again, prior to cataract surgery.

Information, Resources, and Support

In addition to asking questions of your doctor, it is a good idea to conduct your own online research about macular holes, macular hole surgery, vitrectomy, vitrectomy equipment, face-down equipment, and similar topics. If you can, talk with other patients who have been through successful macular hole surgery and recovery. You might ask your surgeon for patient contacts. I was fortunate to obtain valuable information, resources, and support from both professionals and other patients.

Maintaining Face-down Positioning and Use of Equipment

This is critical in order to achieve a successful outcome. As uncomfortable as this is, a successful visual outcome is well worth considerable efforts. Though not necessarily a “compliant” person, I was compulsively compliant during my recovery. I believe that strict compliance would not have been possible for me without the use of appropriate face-down equipment.

A Helper You Trust

I am incredibly grateful to my husband for his help during my recovery period. If you live alone, I strongly recommend that you try to arrange for household and related help in order to maintain the positioning. If finances are a problem, check with your health plan or your county/state/Medicare health services department to see if you qualify for short-term in-home supportive services during your recovery period.

Visitors

Many people wish to be alone when not feeling up to par. However, I found that visitors were a huge help in keeping my mind occupied. I am very grateful to the friends and family who called, visited, sent food, and provided a variety of diversions. Playing simple board games with my grandson, as well as Scrabble with friends, was possible while face-down.

General Precautions

These precautions are my recommendations, based on my own experience and research. Make sure to seek advice from your own surgeon about post-operative precautions.

Eye shield: I wore an eye shield while sleeping during the first week of recovery.
Plane travel: I was advised to avoid flying for several months, or going above the altitude where the surgery was performed. The gas bubble will expand with increased altitude, due to the drop in atmospheric pressure; expansion can cause dangerous pressure within the eye.
Washing my face: I did not get my face wet for several days.
Shampooing my hair: You may want to consider using a dry shampoo for the first week or 10 days.
Swelling: Your face may be swollen for quite awhile on the operated side. This is normal.