Macular Hole: Cause and Treatment.
Fixing A Hole In the Macula Is All In the Details.
It is an opening, a hole, in the central portion of the retina, the macula. It is the part of the eye responsible for seeing fine detail such as letters on a page, numbers on a telephone or the ball in a tennis match. Macular holes occur most frequently in healthy people, most of whom are women in their 60's and 70's.
This photograph shows a normal macula. You can see the round retinal defect in the center of the macula, surrounded by a white halo, which corresponds to a local area of retinal detachment around the edges of the hole.
The inside cavity of the eye is filled with a gel called the vitreous, similar to how air fills the inside of a basketball. Macular holes occur when the portion of the vitreous that lies on the macula spontaneously contracts, pulling some of the macula with it. If the pulling is strong enough, a hole develops along with a small area of retinal detachment, causing loss of fine vision.
How is a macular hole treated?
In rare cases,a macular hole closes on its own. In severe Stage 3 & 4 cases, doctors will perform vitrectomy surgery. They remove the vitreous gel or fibrous membrane responsible for the pulling causing the macular hole. A temporary gas bubble is placed in the eye to seal the hole. The bubble is then absorbed by the body over 10 - 14 days and is replaced by saline produced by the eye. The gas bubble then puts pressure on the macula, causing the hole to flatten and close. Part of the healing process for the patient involves lying face down for approximately ten days.
Until recently, the success rate for repairing macular holes was only 50%. A new technique using a dye called indocyanine green and an instrument developed by Yasuo Tano in Japan made from microdiamond dust allows the tissue causing the macular hole to be removed. The success rates is better than 95%.
