The retina is the layer of tissue that lines the back of the eye that senses light. The macula, is responsible for clear, detailed vision is at very center of the retina. A macular hole is an abnormal opening that forms at the center of the fine vision area over a period of several weeks to months.
Vision becomes blurred and distorted in the early stages of macular hole formation. A blind spot develops in the central vision, if the hole progresses. Side vision remains normal.
The vitreous, or clear gel that fills the eye, gradually pulls on the thin center vision macular area until it tears, it may then stretch open to form a round hole. Other causes of macular hole include trauma and long term swelling.
A macular hole is diagnosed by first examining the retina with an ophthalmoscope. Occasionally a flourescein angiogram photographic test or and OCT may be done to carefully determine the extent of the damage to the macula.
A vitrectomy operation is the only treatment that can repair a macular hole and possibly improve vision. Unfortunately, neither medication nor laser surgery is beneficial.
During vitrectomy surgery, the ophthalmologist uses tiny instruments inside the eye to remove the vitreous gel which is pulling on the macula. The eye is then filled with a special gas bubble to help flatten the macular hole, which will slowly dissolve. After surgery, the patient must maintain a constant face down position for one to two weeks to keep the gas bubble in contact with the macula. This is important as, successful visual result often depends on how well this position is maintained. The macular hole usually closes, and the eye slowly regains part of the lost sight. The visual outcome may depend on how long the hole was present before surgery. Vision does not return all of the way to normal. Surgery is not necessary for everyone who has a macular hole. Some people who have normal vision in the other eye may not be troubled enough to want surgery.
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