Operation Timing

1. I'm told that an operation to correct a macular hole is better done sooner than later. What does that mean? Or, how long do I have to make a decision about whether to have the operation before I run into the "later," and less optimal time for the operation? 2. How long has the operation been used (is it new? established?) Where and by whom was it developed? Is there a clinic or hospital in the U.S. anywhere that specializes in this operation? 3. The operation speeds up the need for a cataract operation following it. Does that mean there are likely to be more cataracts over time? Can the cataract operation improve vision in the eye? More, please, about what this means.... 4. Is it correct that around 5% of macular holes do improve/close on their own? Any ideas at all about why/how that happens? Thanks!

Answer:

Thanks for writing. Here are answers: 1. The visual acuity results after macular hole surgery are better when the macular hole is operated early rather than late, but the time scale for this statement is not precisely defined, and is probably quite broad. By this I mean that it probably makes no difference whether you operate immediately upon diagnosis or in 1 or two months, but it probably does matter if you delay repair for a year. In general, it is best to get as much information as you need, perhaps a second opinion, and then if the best option is surgery, to do it and not procrastinate. 2. The operation was described about 15 years ago, and the success rates and techniques improved for approximately the next ten years. The success rates and techniques now are rather stable and unlikely to change much in the future. That is, the solution to a macular hole - macular hole surgery - is a mature solution. It was developed by Drs. Kelly and Wendel, private practitioners (retina specialists) in California. Macular holes are common and this procedure is done everywhere now. There is no one place that does only macular hole surgery. 3. If you have an early cataract, the operation to repair the macular hole will accelerate the rate of progression of the cataract. That is, you will need a cataract operation sooner than had you not repaired the macular hole. It does not cause "more cataracts". A person only gets one cataract per eye, and once a cataract is removed, that eye never gets another cataract. If you have a macular hole repair and you get a significant cataract, cataract surgery can help your vision if the macular hole repair was successful. Sometimes the macular hole repair does not work. You still get an acceleration of cataract, but in this case removing the cataract might not make much difference in the visual acuity because the macula is not working well. This question is best analyzed on a case by case basis by your retina specialist. 4. Rarely, macular holes spontaneously close (ie repair themselves). The figure you quote - 5% - is too high. Probably, the figure is < 1%. When this lucky event occurs, it is probably attributable to the vitreous body spontaneously and completely releasing from the macula, which can occur. We don't know how to influence this to make it occur more commonly. Good luck with your problem.