Holes in the retina most often occur at the macula, the thinnest part of the retina and the central point of clear, sharp vision. As the vitreous jelly that fills the center of the eye shrinks with age, it pulls on the retina and can tear it at the macula, creating a hole that causes vision loss. Laser surgery repairs the hole by removing the vitreous gel and replacing it with air and gas, which holds the macula firmly in place so it can heal.
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The most common complication after macular hole surgery is acceleration of cataracts in the operative eye. Nearly everyone who has laser surgery for macular hole develops a cataract or has an existing cataract worsen. Cataracts are removed surgically if they occur. Patients who have already had cataract removal prior to surgery won’t experience a re-growth of cataracts.
After macular hole surgery, the patient must remain face down for 50 out of 60 minutes of every hour for up to two to three weeks, All About Vision reports. This allows the gas bubble to put pressure against the macula, sealing it back in place. People who stay face-down have a 90 percent chance of success after surgery, while those who don’t have only about a 60 percent chance of having the hole heal well, the Cleveland clinic warns. A hole that heals well improves the chances of regaining vision, although improvement of vision after surgery also depends on a number of variables, such as the thickness of the hole and the length of time the hole was present before surgery. Vision recovery can take up to 3 months after surgery, the National Eye Institute states. Air travel is restricted until all the gas disappears from the eye, or increased pressure can occur, leading to eye damage.
After laser surgery for macular hole repair, the retina detaches from the back of the eye in 1 to 2 percent of cases, according to VitreoRetinal Surgery. Retinal detachment causes a curtain or veil to appear over a portion of the visual field. Retinal detachment requires surgical repair or vision loss in the area of detachment can become permanent.
Infection in the eye, known as endophthalmitis, occurs in about 1 out of 1,000 cases after macular hole surgery, VitreoRetinal Surgery reports. Symptoms of infection, which include pain in the eye, extreme light sensitivity, swelling, redness in the white of the eye and decreased vision, require prompt medical attention to prevent permanent vision loss. Injected antibiotics or corticosteroids may be required to treat endophthalmitis, reports The Merck Manuals Online Medical Library.