A Macular Hole is an abnormal opening in the center of the macula. Although small, its location in the most sensitive area of the retina can cause substantial loss of vision. Macular holes occur more commonly in females in their 60’s and 70’s, occasionally affecting both eyes. The cause of a macular hole is abnormal traction or pulling by the vitreous gel. It is rarely a result of trauma.
Symptoms include decreased central vision, ranging from 20/80 to 20/400. Due to the location of the macular hole, patients describe a central blind spot, while peripheral vision remains normal. Without treatment, the majority of patients with a macular hole will experience progressive loss of central vision as the hole enlarges.
The diagnosis of macular hole is usually made by characteristic clinical appearance. Optical Coherence Tomography (OCT), a scanning laser that gives a cross sectional image of the retina, is very useful in confirming the diagnosis.
In select cases, a medication called Jetrea can be injected into the eye, dissolving the vitreous gel and promoting hole closure. Significant complications have been noted following injections of Jetrea.
The mainstay treatment for a macular hole is Vitrectomy Surgery. During this procedure, the vitreous gel is removed along with the delicate Internal Limiting Membrane (ILM) that pulls or holds the macular hole open. Under an operating microscope, the surgery is performed 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. Following surgery, it is crucial for the patient to maintain a downward gaze for one week, keeping the bubble in constant contact with the macular hole, thereby promoting hole closure.
In patients able to comply with face-down positioning, hole closure occurs in 80-90% of cases. Most patients experience a significant improvement in vision following successful macular hole repair.