A macular hole is a small break or hole in the central portion of the retina, called the macula. The macula is the central part of the retina which is responsible for distinguishing small details. Macular holes occur most frequently in healthy people and are most common in people in their 60s and 70s.
This upper left photograph shows the normal retina and macula (central part of the macula) appearance. On the upper right, you see a macula with a central macular hole. On the OCT (cross sectional scan), you see that there is a gap in the macula in the center.
Macular holes occur when the portion of the vitreous gel that lies on the macula spontaneously contracts, pulling some macula with it. When the pulling is strong enough, a hole can develop in the center, causing compromise of the loss of fine vision.
How Is a Macular Hole Treated?
In rare cases, the macular hole closes on its own resulting in improved vision. In a majority of cases, retina specialists can perform vitrectomy surgery to close the retinal hole and thus improve vision.
Repair of a macular hole involves two parts:
- Removing the vitreous gel that caused pulling inside the eye, and
- Placing a gas bubble that will put a tamponade on the hole and cause it to close.
Vitrectomy is the term for removing the vitreous gel or fibrous membrane which causes pulling inside the eye. When this gel is removed as well as any other membranes on the retina that causes tension on the tissue, the retina regains the elasticity to close the hole. A temporary gas bubble is placed in the eye to put pressure on the hole, which helps it close. The bubble is then absorbed by the body over weeks and is replaced by the normal saline solution produced by the inside of the eye. In order to help the macular hole close, the patient will position lying face down for approximately one week to place the maximal pressure on the hole and maximize the chance of a successful closure.
Advancements in surgical techniques have improved post-operative macular hole closure rates to better than 95%. Success rates depend on the size of the original hole and the length of time a hole is present. Vision can continue to improve 6–12 months after macular hole closure and the best visual prognosis is achieved when macular holes are operated on within 6 months of the start of symptoms.