| What
is a Macular Hole? 
The healthy retina is a very thin tissue, which lines the back
of the eye. The retina functions like the film in the back
of a camera. The central portion of the retina is called
the macula. This area provides all of the sharp central
vision for activities such as reading and driving. If this
area is damaged, the central vision can be severely affected.
A macular hole, as the name implies, is a condition that
causes a hole to develop in this central area. Macular holes
may occur in a number of ways. They may occur after trauma
to the eye or from inflammation in the eye. Holes forming
from these conditions are more difficult to treat and have
a lower chance of visual improvement.
The most common cause of macular hole formation is simple
traction, or tugging, of the vitreous gel on the macula.
The vitreous is a bag of gel that fills the back of the
eye and presses against the retina. With age, the gel can
become watery in its center and the skin on the back can
tighten and become thicker, pulling on the macula. This
can stretch the macula until it breaks at its center. This
results in progressive loss of the central but does not
usually affect the peripheral vision. The vision usually
decreases to the “E” at the top of the eye chart
but usually not further.
What
Are the Symptopms of Macular Holes?
Patients who develop macular
holes initially notice distortion and waviness in the central
vision, especially while reading. This may slowly or abruptly
worsen. In some cases, the other eye compensates well enough
that the patient notices no vision loss until they cover
the good eye. The peripheral or side vision remains unchanged.
How
Are Macular Holes Diagnosed?
 Macular
holes can be diagnosed with a full eye examination, including
drops to dilate the pupil. Optical Coherence Tomography,
or OCT, is new type of imaging that can very precisely diagnose
macular holes, even in their very early stages. Sometimes
it is necessary to look for associated macular swelling
with a photographic test called fluorescein angiography.
During the test, photographs of the retina are taken and
a yellow dye is injected into an arm vein. Photographs of
the retina following dye injection may show pooling of dye
in the macula in a distinctive pattern, confirming the presence
of swelling associated with the hole.
What
Treatments Are Available for Macular Holes?
Macular holes resulting from
vitreous traction can be closed with an operation called
vitrectomy. In this procedure, the eye is anesthetized and
the vitreous gel is then vacuumed out and replaced with
fluid. If there is any thickened gel, it is peeled from
the macula. The eye is then filled with a gas mixture. The
surface of the gas bubble presses against the macula closing
the hole. The surgery is usually done as an outpatient and
is not painful afterwards. You will use eyedrops for a couple
of weeks after the surgery.
In order for surgery to be effective, the bubble must press
directly on the macula, which is at the very back of the
eye. It is therefore critically important that the patient
look straight down continuously for two weeks. This is by
far the most important factor for success. Patients may
utilize special chairs, beds, and other equipment to make
this easier. Your doctor can discuss this further with you.
This surgery, and especially the gas bubble, may result
in more rapid cataract formation than normal. This is treatable
with routine cataract surgery. In some cases, cataract surgery
is combined with vitrectomy surgery for macular holes. Your
doctor will more fully discuss these issues with you, and
answer any questions you may have.
Surgery succeeds in closing the hole in 80-90% of cases.
In 60-70% of cases, this results in vision improvement.
If there is too much “wear and tear” from having
had the hole, vision may not improve. Complications are
very unusual but include bleeding, infection, and retinal
detachment. Your doctor will discuss this with you and watch
very closely for problems in the postoperative period.
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to the Retina Center
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