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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Healthy Living - September 18, 2018
Many authors have advocated peeling of the internal limiting membrane (ILM) to decrease the possibility of ERM recurrence.1-4 Although ILM peeling has generally been accepted as a fundamental step in macular hole repair, its role in surgery for ERM ...

Alport Syndrome and Vision
Alport Syndrome News
... field of vision. Less than 5 percent of Alport syndrome patients develop a macular hole. Macular holes can sometimes be treated with a surgery called a vitrectomy, which can improve vision and prevent more serious problems, such as retinal detachment.

Eye Surgery
Alport Syndrome News
Less than 5 percent of Alport syndrome patients develop a macular hole, which is a tear in the retina. The eye's interior is filled with a vitreous, gel-like substance, which escapes through this whole and causes blurred or distorted vision, especially ...

MedCity News

Spark Therapeutics Announces Positive CHMP Opinion for One-time Gene Therapy LUXTURNA® (voretigene ...
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 ...
Spark Therapeutics (ONCE) Confirms Positive CHMP Opinion for One-time Gene Therapy

all 41 news articles »

Visual recovery possible after eye injuries from hand-held laser pointers
After dilated ophthalmoscopy, a yellow-orange retinal lesion at the foveola was observed in five eyes, premacular subhyaloid hemorrhage in two eyes and full-thickness macular hole in one eye. High-dose oral prednisone was used to treat all patients.

NMSU Rеpоrt

Vitrectomy Devices Market: Global Market Capacity, Production and Share by Manufacturers Analysis with Forecast to ...
NMSU Rеpоrt
Vitrectomy Devices Market: Type wise segment: – Reusable, Disposable. Applications wise segment: – Epiretinal Membrane, Diabetic Retinopathy, Retinal Detachment, Macular Hole, Others. Get A Sample PDF Of Vitrectomy Devices Market Research Report ...

and more »

Global Retinal Surgery Devices Market 2011-2018 & 2025 - Increasing Incidence of Diabetes Globally Drives Demand ...
PR Newswire (press release)
... as vitrectomy packs, retinal laser equipment, vitrectomy machines, surgical instruments, Tamponades and others are used for the treatment of retinal diseases such as diabetic retinopathy, retinal detachment, epiretinal membrane, macular hole and ...

and more »

Biocompatible film promotes retinal break repair, macular hole closure
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 ...

Predictors of Visual Acuity Outcomes Following Vitrectomy for Idiopathic Macular Hole
Full-thickness macular hole (FTMH) is characterized by a foveal anatomic defect that extends across the entire neurosensory retina and is typically associated with a focal central scotoma. Although a FTMH may occur secondary to trauma or high myopia ...

Inverted ILM flap technique closes large macular holes
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.

Relationship Between Metamorphopsia and Macular Parameters Before and After Idiopathic Macular Hole Surgery
M-score changes before and after macular hole surgery. (A) Postoperative mean M-scores were significantly increased from preoperative M-scores at 3 months (Z = −5.842; P < .001) and 6 months (Z = −5.573; P < .001). No significant differences were found ...

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 epiretinal membranes. A retrospective chart review of 33 patients divided ...

$3 Billion Retinal Surgery Devices Market - Global Forecast to 2025 -
Press of Atlantic City
... as vitrectomy packs, retinal laser equipment, vitrectomy machines, surgical instruments, Tamponades and others are used for the treatment of retinal diseases such as diabetic retinopathy, retinal detachment, epiretinal membrane, macular hole and ...

and more »


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

Vitrectomy Devices Market: Industry Analysis, Size, Share, Growth, Trends, and Forecasts 2017–2022
Vitrectomy Devices Market by Application: Epiretinal Membrane, Diabetic Retinopathy, Retinal Detachment, Macular Hole, Others. The research analysts provide an elaborate description of the value chain and its distributor analysis. This Vitrectomy ...

and more »

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

Retinal Drugs And Biologics Market to Reflect a Holistic Expansion During 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 ...

Autologous retinal transplants are 'true transplants' for macular holes
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 ...

Daily Industry Reports

Vitrectomy Devices Market Analysis of Medical Instruments 2018
Daily Industry Reports
“Global Vitrectomy Devices Market Insights, Forecast to 2025” report presents an in-depth assessment of the Vitrectomy Devices including enabling technologies, key trends, market drivers, challenges, standardization, regulatory landscape, deployment ...

and more »

First-Operated and Fellow Eyes With Bilateral Idiopathic Macular Hole: Comparison of Anatomical and Functional ...
Spectral-domain optical coherence tomography image from an eye with stage 2 macular hole (A). One month after the surgery, ellipsoid zone and interdigitation zone disruption, as well as external limiting membrane restoration are seen (B). Three months ...

Repeat Surgery in Failed Primary Vitrectomy for Macular Holes Operated With the Inverted ILM Flap Technique
Despite significant improvements in vitreoretinal surgery and the fact that in noncomplicated small macular holes (MHs), the success rate may reach 100%, in more complicated cases, up to 39% of MHs may remain unclosed after vitrectomy, which includes ...

Vitreoretinal Surgery Devices Market to Witness Widespread Expansion During 2016 – 2024
Newszak (blog)
Vitreoretinal surgeries are undertaken to treat eye disorders related to the retina, macula, and vitreous fluid. These include macular degeneration, retinal detachment, uveitis and vitreous hemorrhage, macular hole, epiretinal membrane, retinal ...

and more »

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 ...
Laser pointer burns hole in 9-year-old boy's
Is Your Laser Pointer Dangerous Enough to Cause Eye Injury? - American Academy of OphthalmologyAmerican Academy of Ophthalmology

all 65 news articles »

Foveal Avascular Zone Area Analysis in Macular Hole Before and After Surgery Using Optical Coherence Tomography ...
To analyze the foveal avascular zone (FAZ) area in superficial and deep retinal layers in patients with macular hole (MH) before and after surgery. PATIENTS AND METHODS: The authors studied 14 patients with unilateral MH. They examined a 3 mm × 3 mm ...

Patient Recovery Chair Market to Actively Foray into Emerging Consumer Marketplaces During 2018-2026
Latest Market Reports 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 ...

Global Vitreoretinal Surgery Device Market is to be Valued High By 2027 – Research Nester
Market Journal
The complications included for vitreoretinal surgery consists of retinal detachment, uveitis and vitreous hemorrhage, macular degeneration, macular hole, epiretinal membrane or retinal detachment and problems connected to diabetic retinopathy. The ...

What Is Alport Syndrome?
Alport Syndrome News
... is responsible for maintaining the normal color of the retina and the shape of the lens. Abnormal lens shape occurs in about 15 to 20 percent of Alport syndrome patients. About 5 percent of patients may also develop a hole in the macular region of ...

LANews By Abhishek Budholiya (press release) (blog)

Retinal Drugs And Biologics Market to Incur Meteoric Growth During 2017-2027
LANews 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 »

Deccan Chronicle

Shocking: Boy left with untreatable hole in eye after playing with laser pointer
Deccan Chronicle
A scan revealed a large hole in macula (left part of retina), which is crucial for mapping out faces and words. Normally macular holes are treatable, though the surgery inevitably causes cataracts, which permanently clouds vision. However, even that ...
Boy's Eye Burnt by Laser PointerNetralnews

all 9 news articles »

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

The Sun

Boy, 9, left partially blind in both eyes after looking at laser pen 'for two seconds' causing 'bullet hole' damage ...
The Sun
The laser pen caused damage so severe that Archie is now visually impaired with macular scarring and retinal damage in both eyes – and doctors think the injuries are so severe that they may be irreversible. Mum Emma Carson, 30, of Leigh-on-Sea, Essex, ...
Boy blinded himself after shining laser in his eye after his mum told him not toMetro
Boy, 9, virtually blinded in both eyes after looking at laser pen for just two

all 2 news articles »
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