Yellow spot (macula) surface diseases

A special group of diseases of the macula or yellow spot which cause the formation of membrane over the center of vision are called macular surface diseases and they include macular rupture, cellophane maculopathy and vitreomacular traction. 

What is macular rupture (macular hole)?

Rupture of the macula or yellow spot is a retinal defect in the area of ​​the yellow spot and can be partial-thickness hole or full-thickness hole. The disease usually occurs without apparent cause, due to aging of the eye. It is more common in people over age 60 and in women. In a minority of patients eye injuries result in a macular rupture. 

What are the symptoms of macular rupture?

The disease usually occurs in one eye and is completely painless, i.e. the patient does not notice any pain or discomfort of the eye. Macular rupture is divided into four stages, depending on the size of the hole. The fact that the disease usually occurs only in one eye may lead to the late diagnosis of the disease. Since the other eye is usually healthy and patient has good vision, symptoms are not noticed at first or you notice them only if you accidentally close the healthy eye.

Since the disease affects the center of the eye, a person has complete field of view, but complains about impaired central sight, i.e. begins to have problems with noticing facial features and details of the surroundings. When reading a person can notice that there are letters missing or a straight line becomes broken.

What is cellophane maculopathy?

Cellophane maculopathy is a macular disease which causes the formation of the membrane over the center of vision. As the membrane progresses and becomes denser scar tissue, the disease is referred to as macular pucker. 

What are the symptoms of cellophane maculopathy?

The disease is manifested by blurring and distortion of the central image, which is best noticed when reading: the letters are blurred and curves and lines becoming wavy. 

How are macular rupture and cellophane maculopathy diagnosed?

An experienced ophthalmologist diagnoses diseases by eye inspection after pupil dilation, while a more detailed insight into the sheer size of the hole or the thickness of cellophane is achieved by additional non-invasive diagnostic method called OCT (Optical Coherent Tomography). The assessment and classification of the sheer size of the hole is very important for further processes of monitoring and treatment. In fact, small holes and mild cellophanes usually cause mild symptoms and in a large number of cases, patients do not even notice them. Large holes or thicker cellophane membranes produce significant visual loss and usually do not progress but they need to be treated. 

How to treat macular rupture and cellophane maculopathy?

Rupture of the yellow spot is generally treated surgically, although for small holes a drug therapy is available to be administered by injection into the eye. However, this treatment proved to be less effective than expected, so the operation is still the method of choice. Cellophane maculopathy is treated only surgically. 

Surgery to cure this disease of the yellow spot is called vitrectomy. It it classified as a minimally invasive surgical procedure and is carried out under local anesthesia. Through small openings of 1 mm one enters into the deeper parts of the eye and with the finest instruments removes changes pulling or crossing the yellow spot. The operation has a high success rate because the rupture is closed and the cellophane removed in more than 98% of cases. The procedure is quick and painless for the patient. After the surgery patient is immediately discharged and the follow up examination takes place the next day. Stopping vision loss that would inevitably expand is achieved by closing the rupture or by removing the cellophane, and the majority of patients also experience vision improvement. Vision improvement is greater if the disease is diagnosed early. 

The operation in our Clinic is completed by injecting air or gas in the eye, which temporarily puts pressure on the retina and the yellow spot, enabling faster return to its former, normal anatomical shape. The advantage of gas and air is the fact they exit the eye on their own after 2 to 4 weeks and additional operation such as removing the silicone oil is not necessary. 

What is the process of recovery after macular rupture or cellophane maculopathy surgery?

Recovery after the surgery is fast, the eye is neither irritated nor painful. During the next few weeks it is necessary to instill drops and ointment. Since there is air or gas in the eye, vision is gradually returned as the gas exits the eye. It is possible that the operating doctor asks the patient to be positioned lying sideways or sitting with his head down for the first few days. However, in our clinic we routinely do not recommend positioning with the head down. 

Why Clinic Svjetlost?

We plan the treatment individually because our latest generation Swept Source OCT device enables detection even of the most subtle changes. The operation takes about 30 minutes and it is performed under local anesthesia on 25 gauge incisions. The operation is painless and the patient is immediately discharged. Operations are usually ended with air or gas, so the vision is promptly restored. Very often patients also have cataract so we perform a combined procedure of cataract and yellow spot surgery, extending the procedure only 5 minutes, and the patient does not have to be operated twice.