Macular Hole

A macular hole forms when there is traction on the macula from the vitreous that pulls the center of the macula enough to form a hole in the center of the vision.

What is a Macular Hole?

The macula is the center of your retina. It is responsible for your straight ahead vision. While reading the print on this page, you are using your macula. The cornea and lens in the front of your eye focus the image of these words onto your macula. The macula converts the light from the image on this page into a neurological signal that is processed by your brain. Since the very center of the macular is the thinnest part of the retina, it is also relatively weak. Some patients have an abnormally tight attachment between the vitreous gel that fills the eye and the center of the macula. When the vitreous gel contracts with aging, or after an injury, these people can develop a macular hole. Interestingly, 90% of macular holes occur in females. The reason for the female predilection for macular holes is unknown.

Macular Hole Stages

Macular holes are staged from 0 to 4. A stage 0 macular hole is not visible. It only shows up as a vitreous attachment at the center of the macula with optical coherence tomography scanning. Most eyes with stage 0 macular holes never develop a symptomatic macular hole. A stage 1 macular hole is not a full thickness macular hole. It forms when the center of the macula is tented upward from traction but a hole has not formed. Less than half of eyes with stage 1 macular holes develop a full thickness macular hole. Most of these eyes heal on there own. Stage 2 macular holes are small full thickness macular holes. Twenty percent of these holes will heal on there own. Most do not. Stage 3 macular holes are larger macular holes where the vitreous is still attached to the hole. Stage 4 macular holes are larger macular holes where the vitreous is not attached to the hole.

Macular Hole Spontaneous Closure

Small macular holes (Stage II) have about a 20 percent chance of spontaneously closing. The animated image with this text shows a macular hole that closed without surgery. Since macular hole surgery is never an emergency, it is sometimes worthwhile waiting a short time to see if a small macular hole will close on its own. When macular holes abort, or spontaneously close, the vision often returns all the way to normal over the course of about a year. There is often a small piece of tissue that can sit in front of the fovea, a pre-foveal opercula, that can block the vision. In the accompanying image, the patient took over a year for the pre-foveal opercula to pull free of the macula.

Macular Hole Surgery

Surgery is successful in closing macular holes that are less than 6 months old nearly 100 percent of the time. About 90 percent of macula holes close with one surgery. Some require multiple surgeries. Once a macular hole is closed, the vision improves some in 80 percent of eyes, a lot in 50% of eyes (to 20/40 or better), and to nearly normal in 10% of eyes (20/20). Even eyes with normal vision usually have some distortion in the vision for at least a year from the surgery. The risk of surgery is mostly that of retinal detachment (2%-10%), infection (0.01%) and bleeding (0.1%). Cataracts from in most eyes undergoing vitrectomy for any reason in patients over 50. Without surgery macular hole patients usually only lose the very center of their vision. The side vision stays good. Many older patients (85 and up) with a second good eye may decide not to have surgery for macular hole. To repair a macular hole, the surgeon first removes all the vitreous from inside the eye. This relaxes the edges of the macular hole. Many surgeons also do an internal limiting membrane peel further relaxing the edge of the hole. Then the patients eye is filled with gas. The gas pushes the hole closed like a draw bridge. In order for the gas to push on the hole, the patient must look toward the center of the earth after the surgery. Many different surgeons recommend different regimens. Most require a few days to a week of 90% face down positioning. There are pillows and message tables available in most cities for rent if patients want the extra help.

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Most patients with macular hole choose to have surgery. Macular holes over 6 months old can be closed, but the visual acuity results are not as good as they are for fresh holes. Even old holes, five to 10 years old, can be closed with surgery. In these situations there is about a 50% chance of improving vision.

Dr. Pautler's Blog on Macular Hole

Video Macular Hole Surgery without ILM Peel

This patient had a two month history of vision loss from a macular hole. The pre-operative OCT scan showed a stage II macular hole with a diameter of about 250 microns. The scan did not show a taught internal limiting membrane. This surgery is done with a short acting sulfur hexafluoride gas and no internal limiting membrane peel. The patient positioned for a week after surgery (Strict for 3 days). The hole closed and the vision has improved to 20/30 at 2 months.



Video Macular Hole Surgery with ILM Peel

Macular hole surgery in a patient with a stage 2 macular hole. The internal limiting membrane is peeled. A short acting gas was used (sulfur hexafluoride) and vision was 20/50 1 week after surgery. This surgery was done 1 month ago. Vision at 1 month visit was 20/40.



Macular Hole NEWS

Below are current articles from a Google News Feed on Macular Hole

A Patient’s Guide to Eye Disease  U.S. News & World Report

Learn about common eye diseases, as well as the symptoms, causes and treatment options, at U.S. News and World Report.

Treatment of recurrent myopic macular hole using membrane of plasma ri | IMCRJ  Dove Medical Press

Ronald M Sánchez-Ávila, Álvaro Fernández-Vega González, Álvaro Fernández-Vega Sanz, Jesús Merayo-Lloves University Institute Fernández-Vega, ...

Lamellar macular holes: monitoring and management strategies | OPTH  Dove Medical Press

Marco Coassin, Tommaso Mori, Antonio Di Zazzo, Roberto Sgrulletta, Giuseppe Varacalli, Stefano Bonini Department of Ophthalmology, University Campus ...

Healthy Living: July 2, 2019  WABI

BANGOR, Maine (WABI) - A macular hole is a defect in the center of the retina, the critical light sensing part of the eye. Macular holes are most common in ...

Current Management of Macular Hole  Healio

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AZ Retinal Specialists open on Savage | Business  Wickenburg Sun

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Plasma rich in growth factors showed success in macular hole closure  Healio

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Lamellar macular hole surgery – current concepts, future prospects | OPTH  Dove Medical Press

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Autologous retinal transplant successfully closes refractory macular holes  medwireNews

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Biocompatible film promotes retinal break repair, macular hole closure  Healio

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Healthy Living: Macular Hole  WABI

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Inverted internal limiting membrane (ILM) flap technique for macular h | OPTH  Dove Medical Press

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Optical coherence tomography angiography features in patients with idi | CIA  Dove Medical Press

Optical coherence tomography angiography features in patients with idiopathic full-thickness macular hole, before and after surgical treatment Tomasz ...

Surgical outcomes differ depending on type of lamellar macular hole  Healio

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Disorganization of retinal inner layers may be biomarker for macular surgery outcomes  Healio

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Combined central retinal vein, central retinal artery and cilioretinal | IMCRJ  Dove Medical Press

Combined central retinal vein, central retinal artery and cilioretinal artery occlusion with ischemic macular hole secondary to severe orbital cellulitis after black fly ...

Autologous retinal transplantation used to treat macular hole  Healio

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Inverted ILM flap technique closes large macular holes  Healio

An inverted internal limiting membrane flap technique for the treatment of large macular holes offered a higher incidence of type 1 closure with improved ...

Vitrectomy yields more macular hole closures than Jetrea  Healio

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Laser pointer burns hole in boy’s retina  wreg.com

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Incidence and prevalence of vitreomacular traction with and without ma | OPTH  Dove Medical Press

Incidence and prevalence of vitreomacular traction with and without macular hole in Germany Jacob Menzler,1 Aljoscha Steffen Neubauer,1,2 Christos ...

Ocriplasmin not as cost-effective as vitrectomy for vitreomacular adhesion, macular hole  Healio

WAIKOLOA, Hawaii — Jetrea may not be as cost-effective as vitrectomy for vitreomacular adhesion and macular hole closure, a speaker told colleagues here.

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Vascular Density of Retinal Capillary Plexuses in Different Subtypes of Macular Hole  Healio

Ophthalmic Surgery, Lasers and Imaging Retina | BACKGROUND AND OBJECTIVE:To compare vessel density and the foveal avascular zone (FAZ) area ...

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Foveal thinning, deepening may be indicators of macular hole development  Healio

Macular holes may be attributed to discrete anatomic changes such as thinning of the central fovea, according to a study. The retrospective, cross-sectional ...

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Is postoperative face-down positioning necessary after pars plana vitrectomy for repair of full-thickness macular hole?  Healio

Perspective. Face-down positioning is never necessary, regardless of hole size, and is extremely difficult for many patients in this age group. Our practice has ...

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