New gas bubble treatment gives hope for eye complaint

2009-07-24 00:00

SOME eye problems that not so long ago led to visual impairment or even blindness can now be treated with considerable potential success due to advances in microsurgical procedures and the use of specialised diagnostic equipment.

One of these eye problems is a macular hole in the retina, the light sensitive innermost layer of the eyeball.

The hole develops in the focus area of the retina — called the anatomic fovea, which is the point or area of best vision. (See illustration A.)

The reason macular holes develop is unknown but is likely that the gel-like (vitreous) fluid that maintains the shape of the eyeball starts pulling on the fovea causing a hole to develop over time. It is a gradual change and often patients just think that their sight is deteriorating. Macular holes may be associated with trauma in young eyes but are mostly seen in older adults and more in women than in men, at a ratio of three to one.

Some of the symptoms that could indicate the presence of a macular hole are a curve in a straight line or a straight object, a black spot in the central vision in one eye or poor vision in one eye. However, the diagnosis of macular holes and other macular lesions continue to rely largely on clinical examination by an eye specialist using new imaging equipment.

Macular holes develop in stages. (See illustration B.) Sixty percent of stage one lesions have a reasonably good chance of remaining stable or closing, while the majority of stage two holes progress to stage three or four macular holes. Uncommonly, five percent to 12% of full-thickness macular holes demonstrate spontaneous flattening, with subsequent improvement in vision. Usually, a macular hole develops only in one eye but in seven percent to 15% of cases it can develop in the other eye as well.

An eye surgeon repairs the macular hole by making three tiny incisions through the white part of the eye and removing the gel-like fluid from the back of the eyeball as well as a membrane on the surface of the retina. A gas bubble is placed in the eye at the end of the surgery to help close the hole. The gas bubble gets absorbed and replaced by the fluid (aqueous) produced in the eye. Nowadays, it is possible to do the surgery without using any sutures to close the incisions at the end. Patients are asked to keep their heads down by looking three metres ahead for seven to 10 days and by sleeping on their sides and keeping the eye pointing down. This helps the gas bubble to put sufficient pressure on the correct place of the retina and to aid healing. The patient is usually given a general anaesthetic and may stay in hospital overnight. The procedure can also be done under local anaesthetic with sedation.

Enslin Uys is in full-time ophthalmology practice at Netcare St Annes Hospital and Howick Private Hospital, specialising in cataract and retinal surgery. He is married to Mathilda and has one daughter, Bianca, aged four and a half. He can be contacted at 033 342 6604 or 033 342 662.

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