This is an account of a patient who went through macular hole surgery. Here, you will find answers to some of the common questions such as the following:
What to expect after macular hole surgery?
How to sleep after macular hole surgery?
What happens after macular hole surgery?
How to survive macular hole surgery?
So here is how he went through the experience of discovering macular hole in his eye, consulting a doctor, having the surgery and post-surgery posturing:
Discovery and Diagnosis
It comes as a huge shock to the system to wake up one morning and find that the central vision in one eye is distorted, making it impossible to read or watch television in comfort. In my case, reasonable vision is essential as my main pastimes are reading and intricate needlework (using a magnifier). I also use the computer a great deal. I have always been short-sighted but spectacles remedied that and eyesight was just taken for granted.
A few days later I went for a consultation at the Royal Eye Infirmary, expecting to be told it was a problem that could be quickly rectified. At first, after a thorough examination, I was told that the doctor could find nothing wrong and it might be a problem with my prescription spectacles.
As these had served me well, with no problems, for about 18 months, I insisted that there was a major problem, and was sent for a scan. The scan showed a macular hole, which I had never heard of, and I was informed that the only remedy was surgery and that there would be a ‘few days’ post-operation performing what is called ‘posturing’.
I went home feeling very upset and panicky, and immediately checked the Internet for more information.
Although these some of the sites were helpful, there were still many questions which were unanswered, for instance, what improvement in vision could I expect, how long would vision take to improve, and, most importantly, how would I cope with ‘posturing’?
Because a gas bubble is inserted into the eye, the face-down position is essential to keep it in the correct place while the retina heals. This involves lying face-down for a period of anything up to two weeks, with only ten minutes every hour allowed for essentials – washing, applying eye drops, preparing and eating food etc – and, in my case, feeding two cats and keeping their litter trays clean.
The more I thought about this the more impossible it seemed. Concentrated thought was obviously needed to get myself organized and work out just how I was going to cope.
About ten days later I had an appointment with a consultant surgeon, who carried out thorough tests. The consultation lasted approximately one hour, and he confirmed the original diagnosis, with the additional observation that the hole was one of the smallest he had ever seen and was very difficult to find. I asked if this was ‘good, bad or indifferent’ and was told that it should theoretically make for easier closure, but nothing is certain.
The consultant also listed various complications that could arise during or post-surgery which, quite frankly, I would rather not have known about, but I understood the necessity of being fully aware of all possible consequences.
I won’t upset anyone with statistics, but your surgeon will soon enlighten you! He also told me that he was one of the surgeons who insisted on fourteen days posturing – help ! There wasn’t really any choice, so I opted for the surgery and went home feeling even more depressed and anxious.
Positive action was called for, so after much thought I organized the following for my post-operative posturing and recovery:
– A single bed which could be set up in the living room where I could operate the TV with the remote – also the purchase of two single fitted sheets, two single duvet covers and two spare covers for the support pillow.
– An intercom doorbell which was essential as I live alone and wouldn’t be able to get up to answer the door.
– A selection of ready meals for one which could be microwaved in about five minutes.
My consultant would not allow use of a laptop, which was a blow as this was a vital link to the outside world, neither would he allow any kind of reading, using my good eye, as both these activities would mean movement of the eyeball, which was to be avoided at all costs.
I scoured the internet for some sort of head support but without much success, and the one site I did find was very expensive so I decided to rely on the support pillow. With hindsight it might have been worth the expense as I found that my neck and shoulders took much of the strain and regular changes of position were essential.
Macular Hole Surgery
Although I had previously had surgery and general anesthetics I was much more apprehensive this time round, probably because eyesight is so precious and the outcome was uncertain. The surgeon had called it ‘damage limitation’, so I was worried that things might not be much better in the long-term.
I was also concerned that I might develop a macular hole in the other eye (a one in ten chance if you have had one already), in which case my sight would be severely limited. My worst nightmare was that this might happen in the post-operative period when I had little or no sight in the affected eye. However, this operation was essential, so I just wanted it ‘done and dusted’.
After the operation there was hardly any pain, just minor discomfort. I was immediately put into posturing and spent a sleepless night in hospital with my head supported in a frame, looking downwards. It was impossible to get comfortable and if a very obliging nurse had not found me a portable radio I wouldn’t have been able to take my mind off things.
I listened to the radio all night, asking regularly for cups of tea and coffee in my hourly ten minutes respite. In the morning the dressing was removed, which was a great relief. The eye was very bloodshot and puffy, although not as bad as I had expected. After being given instructions on applying the eye drops (three different ones four times a day) I was examined by the surgeon and given the green light to go home.
How to sleep after macular hole surgery?
Adjusting to posturing was not as difficult as I had thought, and the portable TV, laid flat on the floor, was a real lifesaver. My main problem was whether to sit or lie on the bed, and eventually I alternated between the two.
It was more comfortable to sit on the bed and look down at the floor, but the drawback with this was that, with no head support, the strain on my neck and shoulders was too much after about half an hour and I had to go back to lying flat, supporting my neck and chin with an ordinary pillow, so that I could still see the TV. The face down pillow was invaluable for sleeping as it meant my nose was free for essential breathing!
Fitting everything into ten minutes an hour was, frankly, impossible, and I got into the habit of giving myself twenty minutes in the morning while making sure that I postured for one hour and forty minutes before and after, as my consultant had suggested.
Nevertheless, by the time I had washed, brushed my teeth, applied the eye drops, rustled up some toast, fed the cats and seen to the cat litter (carefully using disposable plastic gloves) it did sometimes extend to about half an hour.
Showering was not allowed as water in the eye was to be avoided at all costs, therefore I had to rely on a friend to visit early in the morning to run a bath for me and change the bedding.
This he did regularly, every other day, otherwise I had to rely on a quick stand-up wash at the basin. He also brought me enough sandwiches on his visits to keep me going through the day without having to think about cooking anything.
Another friend visited on alternate days to bring shopping if required, read my emails for me and answer them if necessary, check TV programs for the next couple of days and put finished washing from the previous day into the tumble dryer.
After the third day I got into a routine of microwaving and eating a meal in twenty minutes every evening, relying on sandwiches to keep me going through the rest of the day.
The redness and puffiness of the eye, plus some puffiness in the good eye, persisted for the full two weeks I was posturing, but I was told to expect this, as lying face down all the time would only encourage swelling (edema) in and around both eyes. It was particularly bad on day three.
There were a few minor hiccups:
The new sheets on the single bed caused an allergic reaction on hands, elbows and knees and had to be removed and washed. After this they were changed every other day to avoid the risk of infection and contamination by cat hairs etc.
I tried to convince the cats to sleep on the bottom of the bed but their curiosity meant this wasn’t very successful and I woke up a couple of times to find a cat draped across my neck and back.
Because of constant hand-washing to avoid any infection I developed very dry, cracked skin and had to get some intensive hand-cream, which I applied between washes.
A major hiccup:
On leaving the eye infirmary I had been given bottles of eye drops and, probably stupidly, assumed that I had been given enough to last for the month they had to be applied. The bottles were of heavy plastic and the contents were invisible, so it was impossible to see how much was left. I therefore ran out of one bottle on New Year’s Day – about the worst time possible.
I had to use a taxi to get me to a pharmacy where these drops were sold over the counter, only to find that they were out of stock. That meant an emergency visit to the Eye Infirmary where a doctor very kindly gave me a prescription together with single dose drops to tide me over.
This was probably the most expensive medication I have ever had, as the taxi charged time and a half. So, whatever you do, make sure you have a supply of eye drops available before you run out!
Macular Hole Surgery Recovery and Progress
The first few weeks were very daunting as I had no vision at all in my left eye. Also, the gas bubble was clearly visible, with a horizontal line at the top of my eye below which everything was black. The line gradually moved down my vision and, six weeks later, was reduced to a small bubble which hardly interfered with my vision unless I looked downward.
On the sixth day I noticed, whilst applying eyedrops, what looked like a flap of skin protruding from underneath the eyelid. I also saw a huge black floater. This worried me, so I rang the Eye Infirmary and was told to go in straight away, although they thought it was all normal.
The doctor who saw me was very thorough and confirmed what the nurse had suspected, that the flap of skin under the eyelid was in fact part of the conjunctiva, which had swollen as a result of the surgery, and which should shrink back in the next few days (which it did). The floater was also nothing to worry about and I was told to expect a great deal of ‘debris’ in the eye over the next few weeks.
After three or four weeks my vision gradually started to return. Initially I found it was like looking through a heavy net curtain, with no awareness of colors. Applying atropine four times daily did not help as this keeps the pupil dilated and causes blurred vision anyway.
Slowly, my vision cleared and, as the gas bubble got smaller I was able to see an improvement daily, particularly after the atropine was stopped after a month, and the other drops gradually reduced from four to three to two and then one a day.
Now, after nine weeks, my vision is much improved and, to my vast relief, much better than it was before the surgery. There is still very slight distortion in my central vision, but watching TV and reading are just about normal again.