What is a Macular Hole?
A macular hole is a small break or tear in the macula, the part of your retina responsible for sharp, detailed vision that’s located in the back of your eye. The macula is essential for tasks like reading, recognizing faces, or seeing fine details. When a hole forms, it can cause blurry, distorted vision or even a dark spot in the center of your vision.
Macular holes often occur with aging as the gel-like substance inside your eye (called the vitreous) shrinks and pulls away from the retina. This pulling can sometimes create a hole. Other causes include eye injuries, extreme nearsightedness, or other eye conditions.
How is It Treated?
Early Macular Hole
Full Thickness Macular Hole
Macular holes often begin with a partial splitting of the retina. At this stage, it may close or improve without any treatment. However, once a macular hole tears all the way through the retina, surgery is usually recommended.
The surgery involves removing the vitreous to relieve strain on the retina due to its contraction. During the procedure, the vitreous is separated from the surface of the optic nerve and retina. Following this, a thin membrane lining the retina called the internal limiting membrane, is peeled from the region around the macular hole to relieve any force that may be keeping it open. The eye is then filled with a gas bubble that waterproofs the surface of the retina to allow closure. This gas bubble will blur vision completely while it is present and will be reabsorbed by the body in 1-2 weeks.
During this time, patients cannot travel by air or have anesthesia with nitrous oxide while the gas bubble is present. Patients are usually instructed to lay face-down or on one side for up to a week following surgery to ensure the bubble is against the macular hole while it is healing.
This procedure is usually performed under local anesthesia at an ambulatory surgery center or hospital. Because it requires physically separating the vitreous from the surface of the retina, there is a risk of retinal tears either during or after surgery. Retinal tears identified during this procedure can be treated with a laser and do not lead to retinal detachments. If a retinal tear or detachment occurs after surgery, it must be treated in the office with a laser or may require an additional procedure. However, there is only a 2-5% risk of this occurring.
A side effect of this surgery is that it will cause any pre-existing cataracts to progress more rapidly. This means cataract surgery will be required within 3-6 months after the procedure.