Macular Hole
What is Macular Hole?
A macular hole is a defect, much like a buttonhole that develops at the very center of the macula. Doctors theorize it occurs because the clear gel that fills the eye, the vitreous, pulls on the retina and stretches open the central macula into a hole. Early in the development of a macular hole there is little disturbance of vision. As the central macula is pulled away from its foundation layer, which it needs to function, forming a blister, then developing a “stretch hole” or a rip. Vision is then reduced.
Who develops macular holes?
Macular holes are rare, effecting 3.3 people per 1,000. Predominantly healthy women in their 60’s are afflicted. It rarely causes the blinding condition of retinal detachment. It can be found in younger patients with trauma, diabetics or patients with inflammatory disorders. Ocular Coherence Tomography, OCT, is also employed to measure the retinal thickness and obtain microscopic images of the area of concern. OCT helps the doctor “track” the course of the disease and give actual measurements of the retinal swelling and defects in the retina. OCT can confirm the advancement of a macular hole and its successful surgical closure.
Stages of macular hole
There are 4 stages of macular hole. Stage 1 is an impending or occult hole and usually has no symptoms. Stage 2 is an eccentric oval or horseshoe defect in the macula with symptoms and possible reduced vision. Stage 3 is a full thickness hole with symptoms and reduced vision. Stage 4 is a thickness hole with detachment of vitreous gel from the macula with symptoms and reduced vision.
Treatment for macular hole
Past research has shown that surgery, a vitrectomy, is beneficial for Stage 3 or 4 hole, and not for early stage 1 or 2 holes. Vitrectomy is performed under local anesthesia as outpatient surgery. The surgery takes less than an hour to complete. The vitreous is removed with a miniature hand-held cutting device and replaced with a special solution similar to the vitreous. The vitreous and any “scar tissue” are removed from the retina under a microscope. A gas bubble is then used to fill the eye and push the retina in place, and to force the hole to stay closed during the healing phase. The doctor may require you to keep your “face down,” pointed toward the floor/ground for as much as possible for a 1 to 2 weeks to allow this healing to be successful. The body absorbs this gas bubble over several weeks to months. Vision is poor for the first 6 to 8 weeks after surgery until at least 50% of the gas is absorbed. The success of the surgery in terms of closing the macular hole and improvement of vision is not known until 2 to 3 months after surgery. The surgery can cause retinal detachment, glaucoma, cataracts, droopy eyelids and injury to the optic nerve.