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Macular Hole/Pucker The macula is the region of the retina anatomically located in the center of the retina. It is responsible for providing the sharp, central vision needed to see fine details. A macular hole is a small full-thickness retinal defect in the macula. Epiretinal membrane (also referred to as macular pucker, surface wrinkling retinopathy, or macular wrinkle) refers to the formation of a semitransparent scar tissue on the surface of the retina. With time, this scar tissue can contract and result in distortion of the underlying retina and/or macular edema (swelling). Symptoms People with macular holes may notice: - Loss of central vision - Blurred or distorted central vision This may result in difficulty with reading and driving. The primary symptom of a macular pucker is distorted vision, but it can also result in decreased vision or loss of central vision. While most macular puckers do not affect vision and are found during a routine eye examination, about 1 in 3 macular puckers will affect vision and may require surgery. Causes Macular holes most often result from aging and “bad luck.” Sometimes the vitreous—the gel that fills the eye—can pull on the retina, resulting in a macular hole. In other instances, a membrane (called an epiretinal membrane) can exert traction on the edges of the center of the macula (the fovea) and result in the formation of a hole. Unlike age-related macular degeneration (AMD), there is no genetic link to macular hole formation. The same holds true when comparing this condition to diabetic retinopathy, as there is no systemic cause or environmental factor responsible for macular hole formation. In rare instances, macular holes can occur due to an injury, but most causes of macular holes remain unknown. If you develop a macular hole in one eye, there is less than a 5% risk of developing a hole in the second eye. In macular pucker, on the other hand, most cases are idiopathic, meaning there is no identifiable cause. In some instances a macular pucker can develop after a retinal tear or detachment or secondary to a variety of retinal vascular diseases (diabetes or retinal vascular occlusions). Risk factors Macular holes are most common in people age 60 or older and seem to be more common in women. Age is the primary risk factor for the development of macular pucker, but additional risk factors include: - History of a retinal tear or detachment - Diabetes - Retinal venous occlusions - Inflammation in the eye (uveitis) Diagnostic tests The key diagnostic test for identifying macular holes and puckers is optical coherence tomography (OCT). This technology is also very useful in educating the patient on their condition and in assessing response to treatment. Treatment and drugs Macular holes can be treated with a surgical procedure called a vitrectomy. During this procedure, the vitreous gel is removed and replaced with a bubble of gas and air. Over the course of a few days to weeks the bubble will help the macular hole close. Patients may be required to maintain a face-down position for a few days after surgery to help the gas bubble exert pressure on the hole and help it close. The gas bubble will gradually dissolve and leave the eye over a few weeks. It is important that patients with a gas bubble in their eye not fly or receive inhaled anesthetics during the brief time they have a gas bubble in their eye, as it can result in the pressure in the eye elevating as the bubble expands. Effectiveness of surgery is on a patient-to-patient basis; however, patients who had macular holes for shorter periods of time tend to heal faster than those who had macular holes for several months or years. If a macular pucker is severe and results in loss of vision or significant macular wrinkling, the retina specialist may recommend a vitrectomy and membrane peeling, where scar tissue is peeled from the surface of the retina. Like most surgeries, these procedures carry potential complications: - Cataract formation - Re-opening or persistence of the macular hole - Retinal detachment - Infection - Glaucoma - Bleeding - In cases of macular pucker, a reformation of the pucker Smaller macular holes can, in rare instances, heal themselves. If a macular pucker has no significant effect on vision, the retina specialist may not recommend vitrectomy and instead suggest follow-up visits to check vision and repeat OCT scans to look for any progression in the condition. Prevention There is no way to prevent a macular hole from forming or a macular pucker from occurring.
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staklovine ispunjava otprilike 80 posto unutrašnjosti oka , a sadrži milijune sitnih vlakana koja ga pridaju čvrsto na mrežnici . U djece , debljina staklene je slična onoj od bjelanjka , ali tijekom vremena postupno stanjuje dok ne dosegne mnogo više tekuće konzistencije . Kada se to dogodi , staklovinu može početi smanjivati od površine mrežnice . Kao što je to tako , ona vrši silu na vlaknima ga drži na mrežnici . Kada se to sila postane prevelika , vlakna ometaju mrežnice površine , što dovodi do simptoma makularne rupu . Kirurgiju i oporavak Prema Nacionalnom institutu za oči ( Nei ) ,standardni operacije za popravak makularne rupu jepostupak nazvaovitrektomija . Ako vam je potrebna ovaj tretman ,postupak će se provoditi pod lokalnom anestezijom na bilo u bolničku ili ambulantno . Tijekom svog Vitrektomija , kirurg će ukloniti staklastom iz unutrašnjosti oka i zamijeniti ga privremeno s mjehur plina i zraka . Ovaj mjehur drži rubove makularne rupu u mjestu , a tijekom vremena je njezin tlak potiče makule da vratite na vaše mrežnice . Na kraju ,mjehur rasipa i postupno zamjenjuje tekućine luče iz svog oka . Najteži dio Vitrektomija zapravo odvija nakon operacije . Za vremensko razdoblje koje može trajati od dva dana do tri tjedna, morat ćete ostati u lice - dolje položaj kako bi se omogućilo pravilno makularna ozdravljenje održati . Bez ovog koraka , šanse za uspješan popravak vašeg makule značajno pasti . Ako imate poteškoća u održavanju potrebne držanje , vaš liječnik vam može dati uređaj bi smanjila svoj nemir . Prije operacije , što također može pitati svog liječnika o Vitrektomija opcija koje će umanjiti normalno vrijeme oporavka . Oporavak od Vitrektomija može trajati i 3 mjeseca. Potencijalne nuspojave postupka obuhvaćaju veliku brzinu razvoja katarakte , odvajanja mrežnice i infekcije . Ako se dogodi, vaš katarakte mogu postati ozbiljne . Mogućih ishoda šanse za pozitivan rezultat Vitrektomija u velikoj mjeri ovisi o količini vremena vaš makularna rupa razvijen prije operacije . Ako se vaše stanje postojalo manje od 6 mjeseci prije operacije ,uspješan ishod je mnogo vjerojatnije . Dodatni kirurške metode Od rujna 2009 ,Nei popisi vitrektomija kao jedino dobro razvijene kirurške opcije za liječenje makularne rupe . Dok istraživanje je u tijeku kako bi oplemenili drugog izbora liječenja , nitko drugi tehnika je trenutno spreman za uporabu . Konzultirajte svog kirurga za bilo kakva pitanja vam svibanj imati o detaljima Vitrektomija . From:http://hr.265health.com/surgeries-operations/operations/1016062261.html