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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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.


Multiple extrafoveal macular holes following internal limiting membrane peeling
Dove Medical Press
Objective: Internal limiting membrane (ILM) peeling has been the standard of treatment for macular holes. Besides, causing retinal nerve fiber layer surface abnormality, postoperative extrafoveal multiple retinal holes is a rare phenomenon following ...


Business Wire (press release)

Clinical Trial in Dry-AMD With the Opening of Two Additional US Sites
Business Wire (press release)
Dr. Do is a board-certified ophthalmologist and is an expert in the management of age related macular degeneration, diabetic retinopathy, retinal vein occlusion, retinal detachment, macular hole, retinal infections, and epiretinal membranes. Dr. Do is ...


Vision Test for Alport Syndrome Diagnosis
Alport Syndrome News
Retinal photographs of the central and outer parts of the retina will typically be collected and analyzed to look for any retinopathy, such as dot-and-fleck and macular holes. Macular holes usually require additional observation using optical coherence ...

and more »

Retinal Surgery Devices Market: Growing Preference for Minimally Invasive Surgical Instruments Promises Magnified ...
Expert Consulting
Applications of retinal surgery devices across various ophthalmic conditions such as diabetic retinopathy, retinal detachment, epiretinal membrane and macular hole are driving the growth of the global retinal surgery devices market. Furthermore ...


Global Vitrectomy Devices Market 2018 – Alcon, Bausch and Lomb ...
HugoPress
"Global Vitrectomy Devices Market Size, Status and Forecast 2025 provides Market information about industry Top Key Players, Countries, Type and Application.

and more »

The New Indian Express

'Knowledge transfer must benefit villages'
The Hindu
Health Minister C. Vijaya Baskar on Sunday stressed the need for knowledge transfer in healthcare to reach out to people in tier-II cities and villages. Speaking at the inauguration of the 8th edition of Reticon, a conference on retina surgery ...
Tamil Nadu Health minister inaugurates ReticonDeccan Chronicle
Take healthcare to villages: MinisterNews Today

all 5 news articles »

Retina Group of New York Sponsors Juvenile Diabetes Research Foundation (JDRF) Woodbury, NY Gala
Benzinga
These commonly include diabetic retinopathy, macular degeneration, retinal vein occlusion, retinal detachment, macula pucker, macula hole, cataract surgery complications, uveitis, Plaquenil toxicity and second opinions. The group, led by CEO and ...


The Herald

Big bats, steady pitching carry Cats past Jeeps
The Herald
The impact of the ball shattered Verkamp's orbital bone and he had to undergo several surgeries to correct what the doctors referred to at the time as a macular hole in his retina. Verkamp still wears a mask when he plays to help adjust after the ...


Global Ophthalmic Viscosurgical Devices Market Will Reach USD 606.83 Million by 2023: Zion Market Research
GlobeNewswire (press release)
OVDs are also used in Vitreo-retinal surgical procedures such as macular hole repair and various other retinal surgeries. Government initiatives to increase awareness levels regarding regular eye check-up will increase demand for the products in the ...

and more »

The Truth Today

Retinal Surgery Devices Market Analysis, Market Size, Application Analysis, Regional Outlook, Competitive Strategies ...
The Truth Today
Diabetic retinopathy, retinal detachment and macular hole, epiretinal membrane procedure, and ocular injury and infections are the major disease sites where retinal surgery devices find application. Among these, diabetic retinopathy holds the largest ...


The Quint

QChennai: 500 Cops Yet to Receive April Pay; Several Trains Snarl
The Quint
... general ophthalmologists to understand various state-of-the-art diagnostics and treatment options in vitreo-retinal specialty. The highlight of major breakthrough in vitreoretinal surgery and on a new surgical technique for macular hole repair ...


New Research Report on Retinal Drugs And Biologics Market, 2017-2027
Industry Today (press release)
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 »

High Prevalence of Diabetes, AMD to Fuel Global Retinal Drugs Market
TMR Research Blog (press release) (blog)
The major kinds of retinal disorders include retinal degeneration, macular degeneration, macular edema, retinoschisis, uveitis, macular hole, and macular edema. There has been an increased interest in the production of retinal drugs for the treatment ...

and more »

Retinal Drugs Market Insights by Size, Status and Forecast 2025
satPRnews (press release)
Some of these diseases involve only the macula such as age-related macular degeneration, macular pucker (epiretinal membrane), or macular hole; other diseases can impact the entire retina such as retinal detachment or diabetic retinopathy. The ...


Healio

Autologous retinal transplants are 'true transplants' for macular holes
Healio
NEW ORLEANS — Autologous retinal transplants for macular holes provide “true transplants” and are not just plugs, according to a speaker here. “With the autologous retinal transplant at this stage, we didn't have any major complications. I don't think ...


CNNMoney

Check out how much Medicare spends on drugs
CNNMoney
Also, consumers' costs will differ depending on whether they've hit their deductible or whether they are in Medicare Part D's donut hole, where they have to shoulder more of the burden, or if they are in the catastrophic coverage phase, where they pay ...

and more »

Vitrectomy yields more macular hole closures than Jetrea
Healio
BOSTON — Visual outcomes were similar in eyes with bilateral macular holes that underwent a vitrectomy or intravitreal ocriplasmin injection, but primary macular hole closure rates were higher in eyes that underwent a vitrectomy, according to a poster ...


MD Magazine

CNV Removal Improves Complications with Anti-VEGF Therapy for AMD
MD Magazine
Although, based on their findings, they suggested that “rapid resolution of macular edema and contraction of the CNV and/or mild increase in the vitreous traction after anti-VEGF therapy could potentially cause a macular hole. CNV removal via the ...


Surgical Chairs Market Key Manufacturers, Development Trends And Competitive Analysis 2025
Business Services
Commercially, surgical chairs are available in manual and automatic positioning systems. Ophthalmic chairs are specifically designed to facilitate ophthalmic surgeries such as retinal detachment, glaucoma, macular hole, cataract, and refractive surgery.

and more »

The Sydney Morning Herald

Science relies on light. What about people who can't see?
The Sydney Morning Herald
Dr Tandori's vision is dominated by a black hole, right in the middle, caused by macular degeneration. A major theme of her art is explaining what the world looks like through her eyes. An artist's residency at Monash University's Biomedicine Discovery ...


Vitrectomy Devices Market By Key Players, Product And Production Information Analysis And Forecast To 2022
satPRnews (press release)
Vitrectomy Devices Market by Application Segment Analysis: Epiretinal Membrane, Diabetic Retinopathy, Retinal Detachment, Macular Hole, Others. Vitrectomy Devices Market Regional Segment Analysis (Regional Production Volume, Consumption Volume, ...


Vascular Density of Retinal Capillary Plexuses in Different Subtypes of Macular Hole
Healio
From the Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. Dr. Bandello has received personal fees from Allergan, Alimera, Bayer, Novartis, Farmila-thea, Schering Pharma, Sanofi Aventis, Hoffmann-La ...


Recent top ophthalmology news
Healio
Surgical outcomes differ depending on type of lamellar macular hole. Patients with lamellar macular holes with lamellar hole-associated epiretinal proliferation tend to have worse visual outcomes compared with patients who have highly reflective ...

and more »

The News-Press

Things to do with the kids this Memorial Day weekend, May 25-28, in the Fort Myers-Naples area
The News-Press
The Florida Lions Eye Clinic, Lions Club, Children's Advocacy Center of Southwest Florida and United Way of Lee, Hendry, Glades and Okeechobee are partnering to offer a free eye screening for glaucoma, cataracts, macular degeneration and tests for ...


Surgical Chairs Market- Research by Key players, Type and Application, Future Growth to 2025
Healthcare Trends
Commercially, surgical chairs are available in manual and automatic positioning systems. Ophthalmic chairs are specifically designed to facilitate ophthalmic surgeries such as retinal detachment, glaucoma, macular hole, cataract, and refractive surgery.

and more »

Healthcare Journal

Top Growing Trends & Segments in Global Retinal Surgery Devices Market, 2016-2021
Healthcare Journal
... Vitrectomy Packs, Vitrectomy Machines, Surgical Instruments and Others) for Epiretinal Membrane, Diabetic Retinopathy, Retinal Detachment, Macular Hole and Other Applications: Global Industry Perspective, Comprehensive Analysis, Size, Share, Growth ...

and more »

Few patients need management changes after pars plana vitrectomy
Healio
In a retrospective review of 375 patients after uncomplicated PPV for epiretinal membrane and macular hole with normal postoperative day 1 exam, 97.3% had uneventful postoperative week 1 visits without any need for management changes. Ten patients ...


Vitrectomy in patients 85 years of age and older: surgical outcomes and visual prognosis
Dove Medical Press
Mean improvement in VA in eyes of patients with the comorbidity of age-related macular degeneration (n=34) was 41% lower compared to eyes of patients without the disease (n=48, p=0.013). In the subgroup of patients operated on for retinal detachment, ...

and more »

Surgical Chairs Market: Dynamics, Segments and Supply Demand 2017 – 2025
The Columnist
Commercially, surgical chairs are available in manual and automatic positioning systems. Ophthalmic chairs are specifically designed to facilitate ophthalmic surgeries such as retinal detachment, glaucoma, macular hole, cataract, and refractive surgery.

and more »
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