Definition of a Macular Hole
A macular hole means that the center part of your retina, called the macula, has developed a defect where the retinal tissue is stretched open.
Because the retinal tissue is responsible for our straight ahead or focused vision, a macula defect causes a gray or black spot in the center of vision at the focusing point. The surrounding vision is usually quite normal, creating a “donut” effect with a ring of normal vision and a hole in the middle. The vision is almost never completely lost by this problem. Occasionally, the “hole in the donut” may get larger, but generally this increase is not a severe progression, and the peripheral vision is maintained.
Although we do not know exactly why a macular hole develops in a given individual, it results from traction of the vitreous gel pulling on the center of the macula just enough to create a hole in this area. Unlike tears in the side or periphery of the retina, a retinal detachment does not typically follow the development of a macular hole.
There is a small risk that a macular hole could develop in your other eye. The risk may be as high as 10 or 15%. There may be findings on your examination which allow us to identify a relatively higher or lower risk for you. The strain of the first eye being abnormal does not cause the other eye to develop this problem.
What Kind of Treatment is Available for Macular Hole?
For select patients who have a small macular hole, an in-office injection of a medication called ocriplasmin (Jetrea) into the vitreous gel may be a treatment option. However, for many patients, vitrectomy surgery is required. A vitrectomy is an outpatient surgery usually performed under local anesthesia that consists of removing the vitreous gel that pulled the hole open. In order to seal the hole closed, your doctor will replace the gel with a temporary gas bubble at the time of surgery. This bubble will severely limit the vision in the operated eye for a period of a few weeks, depending upon the type of gas bubble used. The body eventually absorbs this gas bubble and replaces it with natural eye fluids.
Surgery is highly effective in achieving closure of a macular hole, though certain features including size and how long it has been present will influence the success rate. Occasionally, a hole either doesn't close or reopens; in such cases additional surgery may be effective. Surgical success may be enhanced if you can position in a face down manner immediately after the operation for a few days, though with our current techniques there is a trend towards reducing or eliminating the need for such positioning. We can provide you with some useful tips and resources for maintaining this positioning as comfortably as possible if it is recommended.
The amount of vision that can be recovered with successful closure of a macular hole is difficult to predict. Most people do attain some degree of noticeable visual improvement, but the improvement is usually gradual (weeks to months). It is relatively common to have cataract development or progression months after surgery. Patients who elect to have surgery for a macular hole should be aware that cataract surgery may be indicated at some point in the future. Complications of macular hole surgery such as retinal detachment, infection, hemorrhage, and others are very infrequent, although when they occur, they can affect the vision and sometimes additional surgery may be needed. Your surgeon will review the risks, benefits, and alternatives of the treatment options with you and make tailored recommendations based on the unique findings of your eye, including whether any postoperative face-down positioning is recommended.