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

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Study finds predictors of visual outcomes following vitrectomy for macular hole
Healio
Poor preoperative visual acuity, perioperative complications, age-related macular degeneration and delay to surgery are significant predictors of final visual acuity outcomes in patients who underwent small-gauge vitrectomy for full-thickness macular ...


Surgical Repair of Traumatic Macular Holes With Extreme Macular Pathology Using an Internal Limiting Membrane ...
Healio
From Cole Eye Institute, Cleveland Clinic Foundation, Cleveland. Dr. Kaiser has received personal fees from Alcon outside the submitted work. Dr. Singh reports grants and personal fees from Regeneron and Genentech; personal fees from Shire; and grants ...


Ophthalmologist keeps his eye on preventive care
StarNewsOnline.com
Macular holes are among common problems that Cape Fear Retina handles. Others include diabetic retinopathy, retinal detachment and macular degeneration. Interested in promoting preventative care and assisting people with common retinal issues, Cape ...


Global Vitrectomy Devices Market 2018 – Alcon, Bausch & Lomb, Carl Zeiss Meditec AG, NIDEK, Topcon Corporation ...
Honest Facts
Market segment by Application, split into : Epiretinal Membrane, Diabetic Retinopathy, Retinal Detachment, Macular Hole, Others. View Report Details Including TOC : http://www.intenseresearch.com/report/138983. An outlook of the report: The report ...


Risk factors for retinal breaks during macular hole surgery
Dove Medical Press
Masashi Sakamoto, Izumi Yoshida, Ryuya Hashimoto, Hidetaka Masahara, Takatoshi Maeno Department of Ophthalmology, Toho University Sakura Medical Center, Sakura, Japan Purpose: To identify risk factors for retinal breaks during macular hole (MH) ...


Spark Therapeutics (ONCE) Delivers Three Post-hoc Analyses from Phase 3 Clinical Trial of LUXTURNA (voretigene ...
StreetInsider.com
Retinal abnormalities may occur during or following the subretinal injection of LUXTURNA, including macular holes, foveal thinning, loss of foveal function, foveal dehiscence, and retinal hemorrhage. Monitor and manage these retinal abnormalities ...

and more »

Biocompatible film promotes retinal break repair, macular hole closure
Healio
VANCOUVER, British Columbia — A new technique involving a novel biocompatible film can resolve interruption of retinal tissue with a regenerative process, not with a destructive action, and promote retinal break repair and macular hole closure, a ...


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 functional outcomes compared with the standard internal limiting membrane peel, according to a study.


WhaTech

Retinal Surgery Devices market to exhibit steadfast expansion during 2018-2025 according to new research report
WhaTech
Furthermore, On the Basis Application, Market is sub segmented into diabetic retinopathy, retinal detachment, epiretinal membrane, macular hole, and others. The diabetic retinopathy application segment accounted for largest share of the retinal surgery ...

and more »

FastOnlineNews

Retinal Disorders Therapy Market Growth Factors, Applications, Regional Analysis, Key Players and Forecasts by 2025
FastOnlineNews
... Analysis by Types: Each type is studied as Sales, Market Share (%), Revenue (Million USD), Price, Gross Margin and more similar information: Age Related Macular Degeneration, Diabetic Retinopathy, Ocular Inflammatory Disease (Uveitis), Macular Hole.

and more »

Predictors of Visual Acuity Outcomes Following Vitrectomy for Idiopathic Macular Hole
Healio
From the Department of Ophthalmology & Visual Sciences, University of Texas Medical Branch, Galveston, Texas (ALA, MMM); Retina Consultants of Houston, Houston (WCO, CCW, ARS); and Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell ...


Surgical outcomes differ depending on type of lamellar macular hole
Healio
A retrospective chart review of 33 patients divided into three groups depending on the type of macular hole and presence of lamellar hole-associated epiretinal proliferation (LHEP) showed there are two groups of patients that fit the classification of ...


TIME

A Laser Pointer Burned a Hole in a 9-Year-Old Boy's Eye, Doctors Say
TIME
Macular hole, in general, is usually repairable, but it doesn't usually happen from laser pointers,” explains Dr. John Miller, director of retinal imaging at Massachusetts Eye and Ear. (Miller was not involved in the case.) “The laser actually heats ...
Laser pointer burns hole in boy's retinaWSVN 7News | Miami News, Weather, Sports | Fort Lauderdale

all 3 news articles »

LANews By Abhishek Budholiya (press release) (blog)

Patient Recovery Chair Market to Witness Robust Expansion throughout the Forecast 2018 – 2026
LANews By Abhishek Budholiya (press release) (blog)
On the basis of application, vitrectomy recovery, macular hole surgery recovery, mastectomy recovery, dental recovery and other applications have been registered in patient recovery chair market owing to the high level of comfort offered by these ...


Relationship Between Metamorphopsia and Macular Parameters Before and After Idiopathic Macular Hole Surgery
Healio
From Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China (XDL, YW, MG, YY, ZW, JC, WL); the Department of Ophthalmology, Yantai Yuhuangding ...


Latest Market Reports By Abhishek Budholiya (press release) (blog)

Retinal Drugs And Biologics Market Professional Study and Research Report 2017 – 2027
Latest Market Reports By Abhishek Budholiya (press release) (blog)
The disorders related to retinal health include age-related macular degeneration, diabetic retinopathy, infectious retinitis, macular edema, macular hole, retinoblastoma, retinal degeneration, retinoschisis and uveitis etc. There are various types of ...

and more »

Find Market Research By Abhishek Budholiya (press release) (blog)

Retinal Drugs And Biologics Market Latest Innovations, Drivers and Industry Key Events 2017 – 2027
Find Market Research By Abhishek Budholiya (press release) (blog)
The disorders related to retinal health include age-related macular degeneration, diabetic retinopathy, infectious retinitis, macular edema, macular hole, retinoblastoma, retinal degeneration, retinoschisis and uveitis etc. There are various types of ...


The Future Gadgets

Global Retinal Disorders Therapy Market 2018 – ALLERGAN, AbbVie, Alimera Sciences, Janssen Biotech, Swedish ...
The Future Gadgets
A market study based on the Retinal Disorders Therapy Market across the globe, recently added to the repository of Market Research, is titled 'Global Retinal Disorders Therapy Market 2018'. The research report analyses the historical as well as present ...


The Future Gadgets

Global Retinal Drugs and Biologics Market 2018 – ALLERGAN, AbbVie, Alimera Sciences, Janssen Biotech, Swedish ...
The Future Gadgets
A market study based on the Retinal Drugs and Biologics Market across the globe, recently added to the repository of Market Research, is titled 'Global Retinal Drugs and Biologics Market 2018'. The research report analyses the historical as well as ...
Global Retinal Drugs and Biologics Graph, Status and Prospect Report 2018-2023thebusinesstactics.com

all 4 news articles »

CBS News

Laser pointer burns hole in young boy's eye
CBS News
The doctors also found a "large macular hole" in the retina of his left eye. "The child reported playing with a green laser pointer and repeatedly gazing into the laser beam," they write. Because of the large size of the hole, the doctors decided on a ...
Is Your Laser Pointer Dangerous Enough to Cause Eye Injury? - American Academy of OphthalmologyAmerican Academy of Ophthalmology

all 65 news articles »

Coherent News (press release) (blog)

Vitreous Tamponades Market Foresees Skyrocketing Growth in the Coming Years
Coherent News (press release) (blog)
They are majorly used in various retinal disorders such as retinal detachment, diabetic retinopathy, retinitis pigmentosa, retinal degeneration, vascular occlusion, macular hole, epiretinal membrane, macular edema, uveitis, and retinopathy of prematurity.

and more »

Repeat Surgery in Failed Primary Vitrectomy for Macular Holes Operated With the Inverted ILM Flap Technique
Healio
From Ophthalmic Clinic “Jasne Blonia,” Lodz, Poland. The authors report no relevant financial disclosures. Address correspondence to Zofia Michalewska, MD, PhD, Klinika Okulistyczna “Jasne Blonia,” ul. Rojna 90. Lodz, 91-162, Poland; email: ...


Autologous retinal transplants are 'true transplants' for macular holes
Healio
Mahmoud said he performed his first autologous retinal transplant after he was unable to use an internal limiting membrane to close a macular hole and prevent a recurrent detachment. Instead, he used a piece of retina to close the hole and noticed the ...


Foveal Avascular Zone Area Analysis in Macular Hole Before and After Surgery Using Optical Coherence Tomography ...
Healio
From the Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan (FH, AS, HN, AK, HS); and Jakarta Eye Center, Jakarta, Indonesia (FH). The authors report no relevant financial disclosures. Address ...


ME & MY OPERATION: The gene op that could stop me from going blind
Daily Mail
But now there is some hope for serious eye conditions, including, potentially, age-related macular degeneration (AMD), although the treatment might take a slightly different form. For choroideremia, we use a single injection of billions of missing ...


fox8.com

Laser pointer burns hole in Greece boy's retina
fox8.com
Examination revealed a large hole in the macula, a small area in the retina that helps with discerning detail in faces and while reading or driving, the doctors said in a case report published Wednesday in the New England Journal of Medicine. Further ...
Shocking: Boy left with untreatable hole in eye after playing with laser pointerDeccan Chronicle

all 9 news articles »

Global Vitrectomy Devices Market 2022 Company Basic Information ,Production Overview with Industrial Chain Analysis
TheTokenWire (press release)
The description of Global Vitrectomy Devices Market is an In-Depth detailed development which most firmly creating business sector that colossally impacts the worldwide economy to the extent human and regular resources, capital strategic plan ...


This Is The Horrifying Reason You Should Never Stare Into a Laser Pointer
ScienceAlert
When the doctors examined the boy, they found a large hole in the macula - the central area of the retina, where light is focussed from the front of the eye. It's responsible for colour vision and visual acuity. Macular holes are not uncommon in the ...


Vitreous Tamponades Market Anlysis with Inputs form Industry Experts 2018 to 2026
Coherent Chronicle (press release) (blog)
They are majorly used in various retinal disorders such as retinal detachment, diabetic retinopathy, retinitis pigmentosa, retinal degeneration, vascular occlusion, macular hole, epiretinal membrane, macular edema, uveitis, and retinopathy of prematurity.


Retinal Drugs and Biologics Market Size | Global Industry Report 2018-2023
marketresearchday.com
OCULAR THERAPEUTIX. Bausch and Lomb. UCBCares. Segmentation by product type: Age Related Macular Degeneration. Diabetic Retinopathy. Ocular Inflammatory Disease (Uveitis). Macular Hole. Segmentation by application: Hospitals. Clinics. Others.

and more »
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