The minimally invasive vitrectomy or MIVs (vitreoretinal Mini Invasive Surgery)is the latest technology in the field of retinal surgery and the macula.
This looks like the future for any retina related surgery and Dr. Claudio has been amongst the first ones to use it in Europe, since 2011. Click here for more information on Vitrectomy
What is the macular hole?
The macular hole is the formation of a hole in the macula, in the center of the retina.
The macula is an area of 5 mm, the central part of which is called the fovea and it is no bigger than the head of a pin.
What are the causes of macular hole?
Most macular holes are idiopathic or of an unknown cause, although some may be post-traumatic. They are more common in women over the age of 60 years. The reason for women being more affected than men has not yet been found out.
What are the symptoms of macular hole?
In the early stages, the symptoms are similar to other diseases that can affect the macula:
1. Decline of central vision
2. Image deformation or metamorphopsia
3. Central dark spot or a central scotoma
How do you diagnose a macular hole?
The full-thickness of the macular hole must be distinguished from the pseudohole which is located in the epiretinal membrane but not in the retina. The macular hole diagnosis can be made only by an ophthalmologist through:
1) An examination of the fundus, after pupil dilation.
2) An Optical Coherence Tomography (OCT), is a modern and non-invasive examination process for providing a quantification of the problem. The OCT is an ultrasound system that replaces the ultrasound with a laser light and therefore there is no contact between the probe and the eye. The amount of information gathered by the reflected beam of the eye is remarkably high and it can recognize structures measuring up to a few microns.
The OCT Heidelberg Spectralis Blue Peak, installed in Dr. Panico’s clinic, is a unique instrument used for the imaging of the retina.
The instrument we use combines the technology of active eye tracking and blue laser auto fluorescence. This is an unrivaled technology for advanced diagnostics of the retina.
1. It can make 40,000 scans per second with more measurable detail POCHI Micron.
2. It is useful in placing the same points of previous examinations, subsequent testing of the same patient and managing to capture changes in retinal anatomy with a detail of 1 micron.
Without the injection of intravenous fluorescence of OCT blue laser Heidelberg Spectralis, it exploits the spontaneous fluorescence of lipofuscin. This is a product of retinal metabolism, which allows you to obtain fluorescent images and follow the trend of the evolution of malattie affecting the macula, according to a precise pattern.
It is useful in detecting any deterioration of maculopathy, pucker, edema and macular holes, central serous choroiditis and diabetic retinopathy.
The Fluorescein Angiography of the retina (FAG) can be recommended in cases when the existence of multiple pathologies is suspected. Fluorescein angiography involves injecting a dye into the arm and taking photographs of the fundus to see the distribution of the dye among the damaged vessels.
It rarely causes allergic reactions.
What is the treatment of macular hole?
In the early stages, distortion and visual impairment are minimal and tolerable. When the symptoms are blaring and disabling making one compromise the manner of reading and or driving, it is advisable to see the doctor. Even with mild symptoms, there is a tendency of progression and it is necessary to treat it. The treatment of macular hole is exclusively surgical.
Dr. Panico practices a minimally invasive surgery consisting of three small incisions introduced in the white part of the eye (sclera). It is the size of an insulin needle, 400 microns to be precise and in it flow micropinze, microforbici, bright fiber. A tool is used to cut along the vitreous. This microprobe allows the removal of the vitreous. With great care, any remaining vitreous traction on the macula is eliminated. With a microscopic clamp the membrane is then "peeled" from the retina, after staining of the same to increase their visibility.
At the end of the surgery, the vitreous cavity is filled with air or gas. For this, it is required that patients be face down for a few days, to allow the air bubble or gas to buffer the hole during the early stages of wound healing. Most of the times, the crystalline is removed since it provides a final solution to avoid the relapse of cataract. More that 50% of the cases witness a second cataract. The surgery is typically performed under local anesthesia by giving an injection near the eye and does not require hospitalization.
What are the results?
What happens after surgery for macular hole?
The day after surgery, the operated patient has to visit the doctor to make sure there are no early postoperative infections, the intraocular pressure is normal and also to understand the protocol of postoperative infections.
Here are some precautions one needs to exercise after an operation:
• Carry a pair of sunglasses, because the eyes are more sensitive to light for some time
• Use antibiotic eye drops for 2 weeks
• Do not rub the eye operated for three weeks
• Use a protective plastic shell every night for a week.
• Do not part take in strenuous activities for 2-3 days and please refrain from carrying children for a few days.
• Avoid dusty or unhealthy environment for 2 weeks
• On the 3rd day you can shave, wash your face and take a shower but with caution
• You need to sleep face down and keep the position of the head forward during the day.
It is important that you see the doctor 3 times after the operation: after the day of surgery, after one week and after three weeks. This depends on the incubation period of the various germs.