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Giant Retinal Tear
 Vitreous surgery combined with heavy liquids called perflurocarbons is used to repair a giant retinal tear. After the vitreous has been removed, perflurocarbons (PFC) are injected. The PFC is heavier than water. It unfolds the retina. Laser is applied to seal the giant tear and either gas or silicone oil is placed inside the eye to keep the retina in place. The patient may be instructed to keep the face down for up to a week after surgery. Many patients will recover good vision after repair of giant tears, but others may develop PVR and require further surgery, limiting final vision outcome.
Macular Hole
 The first symptoms of macular hole may be slight distortion of vision, which soon progresses to a blind spot in the central vision. The symptoms of macular hole resemble those of macular degeneration initially. Macular degeneration is a totally different problem but occurs in the same place as macular hole.
Macular holes are treated by an outpatient surgical procedure called vitrectomy, membrane peeling and gas fluid exchange. The central gel is removed. The epiretinal membrane is removed from the surface of the macula. The eye is then filled with a special gas bubble. Postoperatively, the patient must position so that the face is down. In this position, the force of the bubble seals the hole. This position must be maintained for 4 days although that may vary depending on the individual. There are several companies that provide equipment to support patients in maintaining the face-down position.
After surgery, the bubble will fill the eye, causing blurred vision when looking straight ahead. However, if the patient looks down and brings an object within a few inches of the eye, the patient will be able to see it clearly. Over time, the bubble dissolves. It may appear as a line in the vision and then gradually get smaller until one day it totally disappears. The time to dissolve depends on the type of gas used. While the bubble is present, the patient is restricted from flying in an airplane and from going to high elevations because this may cause the bubble to expand in the eye, causing severe glaucoma and loss of vision.
The surgery for macular hole has a success rate of over 90%. The visual outcome depends a lot on how soon the surgery is done and how well the patient complies with face down positioning. The better the vision is before the surgery, the better the chance for a good outcome.
Proliferative Vitreoretinopathy (PVR)
Retina detachment repair fails about 5% of the time because scar tissue forms on the surface of the retina. This scar tissue pulls the retina into folds, causing it to redetach, usually within 4 to 8 weeks after initial surgery. When vitreous scarring causes retinal detachment, it is called proliferative vitreoretinopathy.
Repeat surgery with peeling of the membranes is required to reattach the retina. Removing the scar tissue from the surface of the retina is a very delicate process.
After peeling, the eye is filled with gas for silicone oil. Sometimes a large cut in the retina called a retinotomy is made to allow the retina to flatten. If oil is used, it may have to be removed at a later time.
The chance of successful reattachment in PVR cases is about 70%. Reading vision rarely returns. However, useful vision in the range of 20/200 is obtained in about 60% of cases. It takes a long time for complete visual recovery after complicated retina detachment surgery.
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