Dr. Hussein Ayoub
Ophthalmology (Eye Care)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I had a macular hole in my right eye, and my retina detached around five years back, for which a vitrectomy surgery was done, and silicon oil was used. It is stable now. My IOP (intraocular pressure) is quite high, so I am on medication, and pressure-reducing eye drops are prescribed because my eyes fluctuate sometimes. But, I have been diagnosed with a macular hole in the same eye again, affecting my central vision. The doctor advised avoiding surgery as a second macular hole surgery has a low success rate. Kindly help me in making the decision. What should I do? Should I go for the surgery or not? Kindly help.
Hello,
Welcome to icliniq.com.
Yes, I can see that you had a full-thickness macular hole without posterior vitreous detachment, which we call a grade 3 full-thickness macular hole. Honestly, after the surgeries you have already done, I think the only option for you in this eye is autologous retinal transplantation. But please consider that all the trials to save this eye from deterioration are very guarded. You should use an Amsler grid daily for follow-up and report once you have any vision change. I recommend you consult a retina specialist surgeon in your country and ask about the chances of autologous retinal transplantation. It is a complicated surgery, and not everyone can perform it. As for the other eye, you should keep an eye on it as a macular hole can be bilateral. Kindly revert for more queries. Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
Will this hole cause any harm to me in the future, or will it remain still? My retina surgeon told me this hole would remain still, and I did not have to worry. I can ignore it or take the risk of a second surgery if I wish, but only a 20% success rate exists. I am also attaching the diagnosis and prescription. Please have a look at it and help me in making the decision.
Hello,
Welcome back to icliniq.com.
Well, honestly, it is hard to advise if you should go for a second surgery or not. If you are exposed to any kind of trauma that might lead to future problems, it should be stable. Some cases can even progress more with age. I think the more important thing to consider is the other eye. As I have mentioned, many people develop macular holes in both eyes within ten years after the first one. So I would recommend using the Amsler grid daily. A test that we usually advise patients to do is print an Amsler grid online and put it on the refrigerator, for example, and every day you look at it with one eye only, and the other eye is kept covered. You do this simultaneously. If you notice any change, call your retina doctor as soon as possible. This is probably the most practical way to detect any change early. Also, as I have said, I recommend you follow up with an eminent retina surgeon in your home country, as retina surgeons are the best option for your case. Remember, considering that macular holes often come in both eyes, watch for the other eye; that is my best advice. Treatment for macular holes is very guarded since the retina is a neurological tissue, and it will not regenerate once damaged. Amsler grid, you have at least one at your house for early detection, hence better treatment options. Kindly revert for more queries.Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
I am attaching all four surgery details along with the prescription. Please look into it, and help me take the right path. Also, please let me know if the treatment line given to me is fine or does it need any change. My hometown's retina surgeon says he could proceed with the hole closing surgery if I insist. But, the success rate is 20 to 30 percent only, so if the surgery succeeds, my vision will be clearer, and the line I see from the center of my eye will also disappear. He suggests avoiding the hole as it will not proceed further and will cause no harm in the future, and he says the vision will remain still and will not decrease further. Should I get the surgery done? Please go through my history for the five years. Since my eye was operated on and silicon oil was filled, I feel heaviness in my eye, but now even after the removal, I feel the same heaviness and presence of a little bit of swelling. Kindly help.
Hello,
Welcome back to icliniq.com.
I will reach out to you after looking at all the surgery details and reports. Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
I will wait. Thank you.
Hello,
Welcome back to icliniq.com.
It would be better if we do a video consultation for proper assessment. Thank you.
Patient's Query
It’s ok doctor. I will wait for you
Hello,
I will look into your case now and reply shortly
Patient's Query
Hello,
Welcome back to icliniq.com.
Have you sustained any trauma to the head in the past ten years? Have you undergone right eye cataract extraction five years back with a guarded prognosis and silicone oil removal in the same setting? Also, retinal detachment surgery one month after cataract extraction. How was your vision before the cataract extraction surgery? Following that, you had silicone emulsified, for which you had surgery last year. Then you had undergone right eye poor macular hole closure with a very guarded prognosis, andleft cataract surgery. According to the history, your high myopia has caused all of this. If you were my patient, I would not interfere in the right eye again. Your visual prognosis is not good at all. Therefore, you would not likely benefit from the standard surgery. I would suggest an autologous retinal transplant which can help your condition. As I have already mentioned, this is a very recent and advanced surgery. Also, observe the other eye for any changes. Kindly revert for more queries. Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
I did not have any trauma in the past ten years. However, five years back, the silicone removal surgery was done. Before that, I got two surgeries done: the second one was to refill the silicon oil. The vision was quite good after the surgery, and there was no problem till last year. Even I was wearing prescription glasses after that, which improved my vision. Last year, my doctor told me that the IOP is increasing daily and oil removal surgery was done, and some membrane peeling was also done. Even the doctor said there was some cyst in the eye that resolved on its own, which could be the reason for the macular hole. Is it okay if I do not get the surgery done? Or will it worsen the condition?Will, my vision decrease with this hole, or will it remain stable? Kindly help.
Hi,
Welcome back to icliniq.com.
There are multiple risks if you do not undergo treatment like trauma, straining the eye, and pressure inside the eye. So kindly get your eyes checked regularly with OCT (Optical coherence tomography) and the pressure monitored, and you should never exceed 12 mmHg to avoid nerve damage. These factors can also deteriorate your vision. If you are going for the surgery, I would suggest an autologous retinal transplant with an experienced surgeon. Thank you.
Patient's Query
Thank you for your reply, doctor.
What about the swelling and heaviness in my eye? Will it go on its own? I feel some heaviness in my eye like something is filled in it. And it seems quite swollen also. Why is it so? Kindly help.
Hello,
Welcome back to icliniq.com.
What was the intraocular pressure last time you measured it? The swelling might be a sign of high pressure. Do you have pain sometimes? Revert for more queries. Thank you.
Patient's Query
Hi doctor,
Last time my eye pressure was 18/19 mmHg a few days back. Also, I am attaching my pressure details and prescriptions.
Hello,
Welcome back to icliniq.com.
I have gone through your reports (attachment removed to protect the person's identity). I think the pressure needs to be lowered, and the swelling and heaviness may be related to it or related to the eye drops you use. I would suggest eye lubricant as well. But I would suggest an in-person consultation with an eye specialist, which will allow physical examination, and hence the diagnosis can be made of the swelling. Kindly revert for more queries. Thank you.
Patient's Query
Thank you for your reply, doctor.
I have attached all my medical records from the start of the treatment till the present. So kindly go through the reports.
Hello,
Welcome back to icliniq.com.
There is retinal detachment because of myopia. Therefore, I suggest monitoring the eye's intraocular pressure and maintaining it below 15 mmHg. Thank you.
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Ophthalmology (Eye Care)
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