Macular surgery

What is the macula?

The macula is the central area of the retina responsible for central vision, so conditions affecting it can cause significant visual loss. Macular disorders are one of the most frequent causes of retinal surgery.

Which macular conditions usually require surgery?

The macular conditions that most commonly require surgery are:

• Epiretinal membrane: the appearance of tissue on top of the macula that progressively contracts, producing distortion of central vision (called metamorphopsia) and visual loss.
• Macular hole: the appearance of a small defect in the central area of the macula, causing significant visual loss.
• Vitreomacular traction syndrome: due to persistent adhesions between the vitreous (the gel that fills the posterior part of the eyeball) and the macula, distortion of the macula occurs, causing progressive visual loss and potentially ending in a macular hole.

What does macular surgery involve?

The surgery performed in the majority of surgical macular conditions is known as Vitrectomy. It is a minimally invasive procedure performed under local anaesthesia that does not require hospital admission, with a very low-pain postoperative course.

In recent years it has undergone significant advances, making it possible to perform the procedure effectively and safely with very fine instruments (known as 23G and 25G vitrectomy, referring to the calibre of the instruments used, expressed in a diameter measurement called "gauge").

During surgery the vitreous humour is removed and then, using extremely delicate micro-forceps, the membrane that distorts the macula or causes the traction or macular hole is extracted. Given the small calibre of the instruments, sutures are often not necessary, which further reduces postoperative discomfort.

In the postoperative period it will be necessary to instil antibiotic and anti-inflammatory drops for several weeks, achieving progressive improvement of vision in the short to medium term in the majority of cases.