Macular Hole
A macular hole occurs when the center part of the retina is absent of retinal tissue. This tissue
is responsible for our straight-ahead, or focused vision; therefore, when the tissue is missing,
a grey or black spot develops in the central vision. Since the surrounding vision is usually
normal, patients often report that their vision has a sort of "donut" shape. Macular hole is
normally not a progressive condition.
Doctors do not know why macular holes occur, but it is thought to be related to the aging process.
The changes that occur with aging may cause the vitreous to come in contact with the central part
of the retina, pulling it away from its normal position.
Though macular holes tend to occur in one eye at one time, there is an increased risk (10 to 15
percent) that it can eventually occur in the other eye as well.
Some patients may choose not to treat a macular hole. The only effective treatment is a
vitrectomy. This surgical procedure involves removal of the vitreous, replacing it with a type of
gas bubble. After surgery, the gas bubble will cause severely limited vision in the operated eye
for at least a few weeks and maybe a few months. Eventually, the body will absorb the bubble and
replace it with natural eye fluids.
Although vitrectomy is 80 to 90 percent effective for the treatment of a macular hole, it does not
work for everyone. Some patients may need more than one operation. Success is enhanced if the
patient can maintain a face-down position at all possible times after surgery. Our department
has tips on how this position can be maintained as comfortably as possible.
The benefit of surgery to repair a macular hole is hard to predict. Some patients notice a prompt,
significant improvement in their vision. Others may experience only a minimal improvement. A
"fresh" hole is often easier to successfully treat than one that has been longstanding.
As with any type of surgery, there are risks for associated with surgery to repair a macular hole.
Complications are infrequent, but do occur and include serious problems like retinal detachment,
hemorrhage and infection. These complications could cause a severe loss of vision. Persons who
have had macular hole repair are at increased risk for developing a cataract.
Macular hole surgery can be done under local or general anesthesia and usually requires an
overnight stay in the hospital. There is little pain or discomfort involved although some patients
will have difficulty maintaining the face-down position.
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