A macular hole is a defect in the macula, which is the center part of the retina that gives us sharp reading vision. Macular holes usually develop as a result of the natural aging process and called idiopathic macular holes. These occur primarily in the sixth through eighth decades of life. Less commonly, macular holes can be caused by blunt trauma or seen in patients with retinal detachments or severe swelling of the retina.
In the early stages of macular hole formation, the hole may only cause a small distortion of the central vision. As the macular hole progresses, the vision will worsen but will not cause complete blindness.
After a thorough examination of the eye, the physician will perform a series of diagnostic tests. These tests may include a dilated eye examination, fluorescein angiography and optical coherence tomography.
A macular hole usually starts as a small defect and enlarges with time. The earlier these holes are repaired the better the chances for improved vision. There are two available treatments for macular holes depending on the stage of the macular hole. The first treatment involves injecting a medication called microplasmin into the back of the eye called the vitreous cavity. This treatment works best for macular holes that are usually in earlier stages. The more definitive treatment for a macular hole is vitrectomy surgery. The vitreous gel is removed and a very thin membrane is peeled from the surface of the retina. A gas bubble is then placed inside the eye. The most important part of the surgery is the requirement for face down positioning after surgery. In order for the macular hole to close, the gas bubble must press against the macular hole, necessitating the face down position. A variety of devices can aid in face down positioning.
The final visual prognosis depends on how long the macular hole was present and the anatomic characteristics of the macular hole. Most patients recover good vision. Improvement in vision may take anywhere from 3 months to 1 year.