Macular Holes

The macula is the small central area of the retina where light is sharply focused to produce fine detailed and color vision needed for reading and driving. A macular hole is a full-thickness defect that develops in the macula.

Macular holes normally occur along with aging of the vitreous gel which can pull the tissue of the macula until it tears. As the resulting hole progresses over a period of weeks — and sometimes — months, central vision becomes blurred and distorted. Side vision, however, remains normal.

Risk factors to develop a macular hole include trauma, diabetic retinopathy, myopia (near-sightedness), and macular pucker.

Diagnostic testing

Figure 1.

Optical coherence tomography (OCT) is the current gold standard in the diagnosis, staging, and management of macular holes (Figure 1). This quick, non-invasive high resolution scanning technique allows for evaluation of the macula and helps Dr. Uniat differentiate a hole from other eye conditions with similar symptoms. No laboratory tests are needed in cases of idiopathic macular holes (those without a known cause).

Treatment for a macular hole involves intraocular surgery consisting of a vitrectomy (removal of the vitreous gel) and instillation of an inert gas bubble to help seal the hole. The patient must remain in the face-down position for up to two weeks to allow the gas bubble constant contact with the macula. By 4 to 6 weeks the gas bubble will be completely resorbed .

Vitrectomy has a success rate of over 90%, with patients regaining some or most of their lost vision. Potential complications of the procedure include cataract formation, retinal detachment, infection, glaucoma, bleeding, and re-opening or persistence of the macular hole (less than 10% of cases).