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

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 ...

Retinal Drugs and Biologics Market Key Players, End User, Demand and Consumption By 2027  PharmiWeb.com

Retina is a very sensitive and delicate part of human eye which is responsible for receiving and processing light to convert into neural signals and send to the ...

Ala Moshiri  The Conversation US

I am a clinician scientist working as an ophthalmologist and retina surgeon, as well as an laboratory basic scientist researcher studying genetics of eye disease.

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

Lamellar macular hole surgery - current concepts, future prospects Christos Haritoglou,1 Ramin Tadayoni,2 Jean-Pierre Hubschman3 1Herzog Carl Theodor ...

Current Management of Macular Hole  Healio

Ophthalmic Surgery, Lasers and Imaging Retina | Seenu M. Hariprasad, Practical RetinaCo-Editor In this issue's Practical Retina column, Sumit Randhir Singh, ...

Biocompatible film promotes retinal break repair, macular hole closure  Healio

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Macular Hole Formation After Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachment  Healio

Ophthalmic Surgery, Lasers and Imaging Retina | BACKGROUND AND OBJECTIVE:To investigate the incidence, clinical features, and outcomes of patients with ...

Autologous retinal transplant successfully closes refractory macular holes  medwireNews

Autologous neurosensory retinal transplantation results in the closure of full thickness macular holes in the vast majority of patients for whom.

Retinal Drugs Market to Witness Robust Expansion Throughout the Forecast 2017 to 2025 - Press Release  Digital Journal

Transparency Market Research (TMR) is a market intelligence company, providing global business information reports and services. Our exclusive blend of ...

Vitrectomy Devices Market Analysis 2025 by Segments: Product & Application | Top Leaders Topcon, NIDEK, Leica Microsystems, Alcon  openPR

Vitrectomy is a surgical procedure employed to remove vitreous gel from the eye. It is carried out when there is retinal detachment with vitreous hemorrhage.

Predictors of Visual Acuity Outcomes Following Vitrectomy for Idiopathic Macular Hole  Healio

Ophthalmic Surgery, Lasers and Imaging Retina | BACKGROUND AND OBJECTIVE:To investigate predictors of visual outcomes in patients who underwent ...

Updated Cost-Effectiveness of Intravitreal Ocriplasmin for Vitreomacular Adhesion and Macular Hole  Healio

Ophthalmic Surgery, Lasers and Imaging Retina | BACKGROUND AND OBJECTIVE:The purpose of this study is to provide an updated assessment of ...

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 ...

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 ...

Healthy Living: Macular Hole  WABI

BANGOR, Maine (WABI) Treatment of Macular Hole Healthy Living - August 14, 2018. Michael Johnson, MD - Eastern Maine Medical Center. The inverted ...

Repeat Surgery in Failed Primary Vitrectomy for Macular Holes Operated With the Inverted ILM Flap Technique  Healio

Ophthalmic Surgery, Lasers and Imaging Retina | BACKGROUND AND OBJECTIVE:Effects of repeat surgery in failed primary full-thickness macular hole ...

Surgical outcomes differ depending on type of lamellar macular hole  Healio

Patients with lamellar macular holes with lamellar hole-associated epiretinal proliferation tend to have worse visual outcomes compared with patients who have ...

Insightful Forecast on Expansion of Global Retinal Drugs And Biologics Market During 2017-2027  dailychronicle24.com

Retina is a very sensitive and delicate part of human eye which is responsible for receiving and processing light to convert into neural signals and send to the ...

Relationship Between Metamorphopsia and Macular Parameters Before and After Idiopathic Macular Hole Surgery  Healio

Ophthalmic Surgery, Lasers and Imaging Retina | BACKGROUND AND OBJECTIVE:To investigate changes in the pattern of metamorphopsia in patients after ...

Surgical Repair of Traumatic Macular Holes With Extreme Macular Pathology Using an Internal Limiting Membrane Flap Technique  Healio

Ophthalmic Surgery, Lasers and Imaging Retina | This report describes the use of inverted internal limiting membrane (ILM) flap technique as a treatment option ...

Vitreous Tamponades outlook Archives  Business Herald

Vitreous tamponades are essentials used in vitrectomy procedures for healing or reattachment of retina and in vitreous dysfunction. They are majorly used in ...

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 ...

A Laser Pointer Burned a Hole in a 9-Year-Old Boy's Eye, Doctors Say  TIME

A laser pointer caused a macular hole in the left eye of a nine-year-old Greek boy, according to the New England Journal of Medicine.

Retinal Disorders Treatment Market is Expected to Gain Popularity Across the Globe by 2026  Bitcoin Journal

Retinal Disorders Treatment Market Analysis: This study highlights current dynamics and developments in the “Retinal Disorders Treatment Market“. The report ...

EyeMax Mono IOL shows promise in patients with macular disease  Healio

Visual acuity improved in patients with geographic atrophy who underwent cataract surgery and implantation of a novel monofocal IOL in the capsular bag, ...

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

A 9-year-old boy in Greece permanently injured his left eye when he repeatedly gazed into a laser pointer's green beam, doctors say.

Global Retinal Disorders Drugs Market Analysis 2018-19 AbbVie, UCBCares, Bristol-Myers Squibb, Janssen Biotech  Crypto News

The market report, titled “Retinal Disorders Drugs Market 2019“, is an analytical research done by QYResearchStore study based on the Retinal Disorders Drugs ...

Vitreous Tamponades Market Estimated to Observe Significant Growth During - 2026  MENAFN.COM

(MENAFN - Credence Research) The latest market report published by Credence Research, Inc. “Vitreous Tamponades Market - Growth, Futu.

Foveal Avascular Zone Area Analysis in Macular Hole Before and After Surgery Using Optical Coherence Tomography Angiography  Healio

Ophthalmic Surgery, Lasers and Imaging Retina | BACKGROUND AND OBJECTIVE:To analyze the foveal avascular zone (FAZ) area in superficial and deep ...

Autologous retinal transplantation used to treat macular hole  Healio

Ocular Surgery News | Patients who have undergone multiple failed procedures to close macular holes may benefit from a new autologous retinal ...

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 ...

Retinal Surgery Devices Market will acquire $ 2.1 billion by 2021  ZMR Research News

Retinal Surgery Devices Market (Retinal Laser Equipment, Microscopic Illumination Equipment, Vitrectomy Packs, Vitrectomy Machines, Surgical Instruments ...

Laser pointer burns hole in Greece boy’s retina  fox8.com

GREECE – A 9-year-old boy in Greece permanently injured his left eye when he repeatedly gazed into a laser pointer's green beam, doctors say. Examination ...

Macula add-on lens improves quality of life for patients with AMD  Healio

VIENNA — A study assessing the quality of life of patients with age-related macular degeneration implanted with the Scharioth Macula Lens demonstrated ...

Prediction of spontaneous closure of traumatic macular hole with spectral domain optical coherence tomography  Nature.com

It has been known that some traumatic macular holes can close spontaneously. However, knowledge about the types of macular hole that can close ...

Vitreoretinal surgery devices market is anticipated to record a significant CAGR over the forecast period : Top Keyplayers are Bausch & Lomb Inc., Carl Zeiss Meditec AG, MedOne Surgical, Inc., OCULUS Optikgeräte GmbH, Dutch Ophthalmic Research Center Int  openPR

Global Vitreoretinal Surgery Devices Market Overview Vitreoretinal Surgery is conducted to treat eye complications associated to retina, macula and vitreous ...

VIDEO: Gene therapy advances in inherited retinal disease, AMD, optogenetics  Healio

WAIKOLOA, Hawaii ― Elias Reichel, MD, discusses the latest advances in gene therapy for inherited retinal diseases, age related macular degeneration and ...

Visual recovery possible after eye injuries from hand-held laser pointers  Healio

Commercial hand-held laser pointers can inflict macular injuries, but good visual recovery is possible. A study included eight eyes of seven patients who ...

Kodiak's investigational anti-VEGF yields positive results  Healio

Kodiak Sciences' drug candidate KSI-301 improved vision, anatomy or both in eight of nine patients with severe diabetic macular edema in a phase 1a trial, ...

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Read more about the case of Portuguese woman with a COL4A4 mutation who developed large holes in the retina of both eyes.

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CHICAGO — At the Ophthalmology Innovation Summit at AAO, Quinton Oswald, CEO of Notal Vision, discusses the company's pursuit of an OCT home ...

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At the annual American Academy of Ophthalmology meeting in Chicago, Healio.com/OSN talked with key opinion leaders regarding important ophthalmic ...

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HDL cholesterol and triglycerides have, respectively, a positive and negative association with increased risk for age-related macular degeneration, particularly in ...

Retinal Drugs and Biologics Market and Consumer Consumption Statistics 2018 and Forecast to 2023  Times Ohio

A market study based on the “ Retinal Drugs and Biologics” across the globe is titled 'Global Retinal Drugs and Biologics 2018'. The research report analyzes ...

One in four anti-VEGF therapy patients with DME lost to follow-up  Healio

A quarter of patients with diabetic macular edema who received an anti-VEGF injection to treat nonproliferative diabetic retinopathy did not return for a follow-up ...

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This Is The Horrifying Reason You Should Never Stare Into a Laser Pointer  ScienceAlert

If you've ever wondered why you shouldn't direct a laser pointer at your eyes, let a 9-year-old boy in Greece be your cautionary tale: by repeatedly staring into a ...

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WAIKOLOA, Hawaii — Gene therapy for retinal disease is in various stages of development, with more than a dozen retinal clinical trials underway, Elias Reichel ...

Increase in choroidal thickness seen after CPAP therapy  Healio

Patients with obstructive sleep apnea syndrome who underwent continuous positive airway pressure therapy experienced an increase in choroidal thickness ...

Saving sight without surgery: Macular holes  WFTV Orlando

BACKGROUND: A macular hole is a small break in the macula, the center of the eye's light-sensitive tissue called the retina.

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WAIKOLOA, Hawaii — At Retina 2019 here, Peter K. Kaiser, MD, discusses the latest treatments in development and their mechanisms of action for treating ...

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Notal Vision's home-based OCT system granted breakthrough device designation  Healio

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Ophthalmology Blogs | Mali | There is no question that the introduction of anti-VEGF agents has dramatically changed the landscape of how surgeons approach ...

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

Optimal management of idiopathic macular holes | OPTH  Dove Medical Press

Optimal management of idiopathic macular holes Haifa A Madi,1,* Ibrahim Masri,1,* David H Steel1,2 1Sunderland Eye Infirmary, Sunderland, 2Institute of ...

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BioTime has entered into a research and option agreement with Orbit Biomedical regarding technology to deliver OpRegen to treat dry age-related macular ...

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MacuLogix Inc. has launched AdaptDx in Europe at the Euretina meeting in Vienna.The dark adaptometer is designed for clinical use to detect age-related ...

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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An orange a day keeps macular degeneration away: 15-year study  Science Daily

A new study has shown that people who regularly eat oranges are less likely to develop macular degeneration than people who do not eat oranges.

Boy burns hole in his retina after aiming a laser pointer right at his eye  Globalnews.ca

A 9-year-old boy may have permanently damaged his eyesight after playing with a green laser pointer.

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VIENNA ― At the Euretina meeting here, Jay Chhablani, MD, discusses safety results of a large cohort of patients with diabetic macular edema treated with ...

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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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.

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Compact Imaging has signed a collaboration agreement with Novartis Pharma to develop a home-based monitor to detect progression of age-related macular ...

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The first patient has been dosed in a phase 1 trial of ADVM-022 gene therapy for wet age-related macular degeneration, Adverum Biotechnologies announced ...

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BOURNE – U.S. Congressman Bill Keating (D-MA-9th District) has been out of Washington D.C. for the past few weeks. The Bourne Democrat has been ...

Risuteganib complements anti-VEGF treatment for diabetic macular edema  Healio

VIENNA — Integrin inhibitor risuteganib was effective in complementing the anti-VEGF pathway when administered sequentially to an anti-VEGF drug in patients ...

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Cataract surgery patients treated with branded nepafenac topical eye drops reported better objective and subjective outcomes compared with patients treated ...

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Dosing is complete in a phase 1 clinical trial of RGX-314, a gene therapy treatment for wet age-related macular degeneration, according to a press release from ...

Recent top ophthalmology news  Healio

Here are some of the latest top stories on Healio.com/OSN:

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Steroids and NSAIDs can be synergistic  Healio

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Iluvien has been approved by Health Canada, Alimera Sciences announced in a press release.A fluocinolone acetonide sustained-release intravitreal implant, ...

Bausch + Lomb, Modulight to develop laser for Visudyne  Healio

Bausch + Lomb and Modulight have entered into an exclusive agreement to develop a laser for use with Visudyne photodynamic therapy, according to a press ...

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CHICAGO — The 6-month results of an ongoing phase 1 study evaluating RGX-314 gene therapy for patients with wet AMD showed positive safety and patient ...

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MILAN — A condition that looks like age-related macular degeneration may not be, Keith A. Warren, MD, said at the OSN Italy meeting. He spoke here about ...

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More inflammation observed after aflibercept vs. ranibizumab injection  Healio

VANCOUVER, British Columbia — While eye pain outcomes were similar within a week of injection of either aflibercept or ranibizumab in patients with diabetic ...

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Biosimilars for bevacizumab and ranibizumab show promise for retinal diseases  Healio

VANCOUVER, British Columbia — Data for two new biosimilars for ranibizumab and bevacizumab, currently available in India, show the treatments are safe and ...

Brolucizumab meets secondary endpoints for fluid resolution in wet AMD  Healio

A new data analysis of prespecified secondary endpoints of the phase 3 HAWK and HARRIER trials showed that retinal fluid was detected less often in patients ...

Corticosteroid implant shows positive real-world outcomes in severe cases of DME  Healio

VIENNA — Real-world 3-year data from the RETRO-IDEAL study showed that advanced diabetic macular edema cases can benefit from being treated with the ...

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