Macular Hole

A Macular Hole is an abnormal opening in the center of the macula. A macular hole is small, but because it occurs in the most sensitive area of the retina, it can cause substantial loss of vision. Macular holes occur more commonly in females in their 60’s and 70’s, and occasionally affect both eyes. Abnormal traction, or pulling by the vitreous gel, creates the macular hole. Rarely, they are the result of trauma.

Symptoms include decreased central vision, ranging from 20/80 to 20/400. Because of the location of the macular hole, patients describe a central blind spot. Peripheral vision remains normal. Without treatment the majority of patients with a macular hole will experience progressive loss of central vision after the hole develops.

The diagnosis of macular hole is usually made by characteristic clinical appearance. Optical Coherence Tomography (OCT), which is a scanning laser that gives a cross sectional image of the retina, is very useful in confirming the diagnosis.

The mainstay of treatment for a macular hole is surgery. During vitrectomy surgery, the vitreous gel is removed, including the delicate Internal Limiting Membrane (ILM) which is pulling or holding the macular hole open. The surgery is performed under the operating microscope using very fine instruments. An absorbable gas bubble is placed in the eye to seal the hole. Removing the vitreous is not harmful to the function of the eye. Vitrectomy surgery is an outpatient procedure performed under local anesthesia. After surgery it is crucial for the patient to maintain a downward gaze for one week. This keeps the bubble in constant contact with the macular hole, which will promote hole closure.

Vitrectomy for Macular HoleFace Down Position
Vitrectomy for Macular Hole and Face Down Positioning

Jetrea is an enzyme which dissolves the vitreous. Injecting Jetrea into the eye can allow very small macular holes to close. Compared to vitrectomy surgery, Jetrea is far less successful in closing macular holes. For this reason, Jetrea is less often recommended.

Until recently, macular holes were untreatable. Advanced microsurgical techniques combined with patient cooperation now allow for very high rates of surgical success. Most patients experience a significant improvement in vision following successful macular hole repair.

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Macular Hole Before Vitrectomy
OCT of Macular Hole Before Vitrectomy.
Same Eye With Normal Macular Contour Following Vitrectomy.
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