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Macular Hole

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What is a Macular Hole?

A macular hole is a full-thickness defect in the fovea, the center most part of the macula responsible for detailed vision.

What are the symptoms of a Macular Hole?

In the early stages of macular hole formation, central vision becomes slightly blurred and distorted. If the hole progresses, a blind spot develops in your central vision. This impairs seeing at both distant and close range. Symptoms of macular hole usually occur in one eye only as it is uncommon to develop macular hole in both eyes.

What causes a Macular Hole?

Your eye is filled with a gel-like substance called vitreous, which fills the large cavity in front of the retina. The vitreous gel shrinks and shifts away from the macula, usually with no negative effect on your sight. In some cases, however, the vitreous gel exerts traction on the macula and leads to formation of a hole.

Macular holes usually occur in people over the age of 60. Most are considered idiopathic (unknown cause). Less common causes of macular holes include injury to the eye (trauma), extreme nearsightedness (myopia) and long-term swelling of the macula. (e.g. retinal vein occlusion).

How is a Macular Hole diagnosed?

Your optometrist or ophthalmologist will dilate your pupils and examine your retina.

Special testing, especially optical coherence tomography (OCT), allows for accurate macular hole diagnosis and staging. OCT can show small macular holes that are too small to be seen in an examination or with fluorescein angiography.

What is the treatment for Macular Hole?

Vitrectomy surgery is the standard of care to attempt repair of a macular hole.

Macular hole surgery starts with vitrectomy to remove vitreous gel exerting traction on the macula. The eye is then filled with a temporary gas or oil bubble to help flatten the macula while it heals. Some retinal surgeons apply a biologic "super glue" made from the patient's own blood to help seal the foveal defect.

Face-down positioning after surgery keeps the bubble in contact with the macula to maximize hole closure. A successful result often depends on how well this position is maintained. A gas bubble will slowly dissolve on its own. Silicone oil cases require an additional procedure to remove the oil several weeks to a few months following surgery.

If you have a gas bubble you cannot fly in an airplane until the gas has been reabsorbed, as a rapid increase in altitude can cause a dangerous rise in eye pressure.

Macular hole surgery is highly successful in terms of anatomic in improvement (hole closure). How much vision is ultimately restored generally depends on the size of the hole and how long it was present before surgery. Optimal vision may not be obtained until cataract surgery is performed.

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