Macular holes, tears or small holes in the macula of the eye, can cause distorted and blurry central vision and may require surgery called a vitrectomy. The surgery involves removing the vitreous gel and replacing it with a combination of gas and air to keep the edges of the macular hole in place as it heals. Patients may need to keep their faces down for a day or two after surgery, and risks include cataract formation, infection, or retinal detachment.
A macular hole is typically defined as a tear or small hole in the macula of the eyeball. The macula is the pigmented spot in the center of the retina responsible for sharp, sharp central vision. The location and size of a macular hole on the retina usually determine the severity of the visual impairment. If left untreated, this condition could develop into a detached retina. A detached retina often threatens vision and is generally considered a medical emergency.
Macular holes are generally related to the aging process and affect people over the age of 60. Symptoms can include distorted and blurry central vision. Typically, in the early stages of macular holes, patients often experience only a slight blur or distortion in their central vision. Straight lines can take on a bent or wavy appearance. Performing routine tasks and reading often become difficult.
Causes of a macular hole could include nearsightedness, retinal detachment, diabetes, and eye injury. If a macular hole is present in one eye, there is often a 10-15% chance that another macular hole will occur in the other eye in a lifetime. Macular holes usually start gradually and the patient is often unaware of the condition.
Sometimes, macular holes can close on their own, however in many cases surgery may be needed to improve vision. The surgical procedure is called a vitrectomy. Vitrectomy is the removal of the eye’s vitreous gel to prevent it from pulling on the retina and replacing it with a combination of gas and air. This combination of gas and air forms a bubble, which acts like a bandage to keep the edges of the macular hole in place as it heals. Macular hole surgery is usually done as an outpatient procedure with a local anesthetic.
After surgery, patients usually have to keep their faces down for a day or two. In some cases, it may be necessary to hold this position for two to three weeks. The face-down position helps the bubble apply pressure against the macula, allowing it to be reabsorbed into the eye. This will usually seal the hole and allow the socket to fill with eye fluid.
Risks of a vitrectomy include cataract formation, infection, or retinal detachment. Patients are usually advised not to travel by air because fluctuations in air pressure could cause the air bubble to expand, increasing intraocular pressure. Visual improvement after surgery varies from person to person. Individuals who have had a macular hole for six months or less typically have a more favorable chance of recovering lost vision.
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