A macular hole refers to a hole affecting the central part of the retina – called macula. It is commonly seen in the over 60’s population and tends to be more common in women than men. It presents with a sudden drop in vision usually associated with distortion (straight lines appear “wiggly”). With time, the macular hole becomes larger, causing further deterioration in vision. The exact cause of why these macular holes occur is not yet fully understood, but traction from the vitreous on the macula plays a pivotal role. The diagnosis is made by your eye surgeon after a retinal examination through dilated pupils. New high resolution imaging techniques have been introduced providing additional information on pathogenesis and prognosis. The most effective of these is Optical Coherence Tomography (OCT) which produces an optical cross section of the retina, thus allowing excellent visualization of the macular hole.
Vitrectomy Surgery for Macular Holes
The only current treatment for macular holes is surgery called vitrectomy, where the “gelly” (vitreous) inside the eye and the very superficial layer of the retina (Internal Limiting Membrane – ILM) are removed. A bubble of gas is placed inside the eye that acts as a splint to close the macular hole. The vision will be very blurred after the surgery because of the gas inside the eye. This gas is gradually absorbed by the eye, and when it disappears the vision usually improves.
Eye drops are required for a few weeks after the surgery that reduce the inflammation in the eye. There is a 90-95% chance of closure of the hole with this type of operation, and the improvement in vision will depend on how long the hole has been present.