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Macular Hole

The retina is a tissue that lines the almost the entire inside of the eye. It is a very specialized tissue that collects light information and transmits it to the brain providing us with vision. The macula is a small portion of the retina at the back of the eye that is responsible for central vision and gives us our fine detailed vision and color perception. The posterior segment of the eye (inside of the eye, behind the lens) is filled with a gelatinous substance called vitreous. When we are young, the vitreous is a consistent gel and is adherent to the retina. Over time as we age, parts of the vitreous gel become liquefied and other parts clump together (perceived as floaters). Also as a part of normal aging, the vitreous will release itself from the retina (posterior vitreous detachment - PVD). This usually occurs without consequence but can cause retinal tear, retinal detachment and other problems. Before a PVD occurs, the vitreous may partially separate directly over the macula. If it remains adherent at the very central portion, traction here can result in a full thickness hole developing at the central macula – called macular hole.

With macular hole there is central distortion of vision making reading very difficult with the eye. This usually develops in just one eye, but those who get macular hole may have an abnormally adherent vitreous and there is a 10-20% risk of developing a similar hole in the other eye.

Macular hole can be repaired with vitrectomy surgery. This surgery is performed under local anesthetic as a day surgery procedure. Please refer to the page on vitrectomy surgery for further information about this procedure. When this surgery is performed for macular hole, a special maneuver is performed to remove the tractional forces from the central macula (membrane peeling) and at the end of surgery, the eye is left filled with a short acting gas bubble. The gas floats inside the eye and is used to support the macular area to ensure closure of the hole – this requires 5-7 days of positioning face down after surgery. Vision is extremely limited through the gas bubble but one can see around it after 1 week and the bubble is totally gone by 2 weeks after surgery. One cannot fly in an airplane or travel to the mountains with a gas bubble in the eye.

Surgery results in successful closure of the macular hole in about 95% of cases. There is usually significant vision improvement when the hole closes but the vision recovery can be gradual over several months. The vision does not recover completely to normal. Some mild central blur and distortion usually persists. If the macular hole has been present for a long time, the vision result is more limited.

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