Macular indentation

o The IMO reintroduced this technique into Spain
14
years ago
Indicated for the
50 %
of high-myopia sufferers who suffer from staphyloma
Surgery takes about
90
combined with vitrectomy
Macular indentation

What is macular indentation?

Macular indentation is a surgical technique used to treat very specific cases of retinal detachment, specifically, those that arise as a result of a macular hole in patients with high myopia. These complications are due to a type of deformation of the posterior area of the eyeball from which approximately 50% of high-myopia patients suffer. This lesion, known as staphyloma, is caused by abnormal growth of the myopic eye and causes traction on the retina, which can affect the central area (macula) and lead to serious consequences for vision.

When is it carried out?

This technique is indicated for patients with retinal detachment caused by a macular hole due to high myopia.

Prior examination

Before the procedure, the retinologist carries out a complete ophthalmic examination of the fundus. Optical coherence tomography (OCT) is also used to scan the layers of the retina and assess the extent of damage to the macula.

During surgery

This surgical procedure, whose reintroduction into Spain was pioneered by the IMO more than a decade ago, consists of placing a silicone or polymethyl methacrylate implant (‘indenter’) on the back of the eyeball, where the staphyloma appears.  The main function of this piece is to exert pressure on the area where the deformation is located to help reapply the detached retina.

A vitrectomy is also performed to extract the vitreous gel. During this part of the procedure, the surgeon injects gas or silicone oil into the ocular cavity with the aim of reattaching the retina.

Both techniques are carried out under local anaesthesia and take between one and two hours, depending on each patient’s case.

After surgery

At the end of surgery, the operated eye is covered. After 24 hours, the ophthalmologist makes a postoperative visit and removes the ocular occlusion. 

Patients who undergo surgery do not usually experience pain, but may feel some discomfort, such as inflamed or red eye during the first 3 weeks. Postoperative recovery varies depending on the substance that the surgeon uses to reattach the retina:

  • If gas has been injected, the patient should remain face down in the prone position for 5 days. In the days following the operation, the patient will also notice a gas bubble in their vision, which gradually disappears within 2 weeks.
  • If silicone oil is injected, the patient may notice changes in their vision and a second operation may be necessary to remove it after 2-8 months.

In both cases, the patient gradually regains vision and the results are considered definitive one year after the procedure.

Risks

This surgery has no more risks than those associated with any surgical procedure. In exceptional cases, some patients may experience bleeding or postoperative inflammation. 

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