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A patient who was initially doing well after a recent cataract surgery, experienced a sudden worsening of vision. Their eye became red, and they developed severe pain. The vision had worsened from 20/30 (two lines from 20/20) to counting fingers (only able to count fingers of the examiner presented one foot away from their face). I examined the patient, who had severe inflammation in the eye, and I performed an ultrasound of the eye, which showed dense inflammation in the vitreous cavity.
Much like a cast immobilizes a limb and helps it heal, during retinal surgery, your surgeon may use an analogous immobilization/healing aid. Surgery on the retina that requires removal of the vitreous gel (called a vitrectomy) sometimes requires placing a vitreous substitute that exerts a force on the retina to flatten the retina. While the vitreous can be replaced with saline in cases where no such force is necessary, many retinal conditions such as retinal detachments and macular holes, require placing a gas mixture or oil in the eye.
Central vision is critical for many daily activities ranging from reading to driving. Clear vision requires light be focused on a transparent tissue in the back of the eye called the retina. The retina has different regions, but the portion of the retina responsible for our central vision is known as the macula, and within the macula, the finest acuity is provided by a specialized portion known as the fovea. The fovea is where light is focused in our eyes to allow us to see fine details in the world around us. Diseases involving the fovea affect our ability to perform our day to day activities. One such condition is macular hole formation. Macular holes develop when the clear gel inside the eye (the vitreous) tugs abnormally on the retina. This tugging creates a hole. In rare cases, macular holes can develop after injury to the eye. Most of the time, it occurs because some people are born with abnormal attachments between the vitreous and the retina. As we age, the vitreous naturally liquefies and pulls away from the retina. In people born with abnormal attachments to the fovea, the gel does not peel away easily from the fovea, so when it pulls away it leaves a hole. Unfortunately, there is no way to predict who will develop a macular hole. When a hole develops, the central vision becomes blurry. If one does not check vision in each eye individually, the effects of a macular hole in one eye can go unnoticed for weeks or even months. Without intervention, the hole can enlarge, and more central vision can be affected. Most of the time, this occurs in only one eye, but 1 out of 5 patients can have this occur in both eyes.