The macula is the central part of the retina, a thin membrane that lines the back wall of the eye. The macula is responsible for your distance, color, and reading vision. The very central part of the macula is called the fovea, which is the location responsible for detailed vision. This is the region that is affected by macular holes. In between the lens in the eye and the retina lies a jelly-like substance called the vitreous gel, which has a vital role in developing macular holes.
Possible signs of a macular hole include a gradual onset of loss or distortion of the central field of vision.
Causes of Macular Holes
Macular holes may be caused by injury or inflammatory swelling of the retina, but they most commonly occur as an age-related event without predisposing conditions. The vitreous gel is tightly attached to the retina when you are born but gradually separates from the retina as you age. Macular holes are caused by pulling or traction as the vitreous gel separates from the retina in the macula and around the fovea.
Treatment of Macular Holes
Surgery is the treatment of choice for full-thickness (meaning a hole through all layers of the retina) macular holes. The surgery involves the removal of the vitreous gel sac through three microscopic incisions through the sclera. A small scar tissue or membrane layer may also be removed from the retina’s surface. A gas bubble is then placed in the eye.
The surgery takes less than an hour with minimal discomfort. The patient is then asked to maintain a face-down position for three to seven days, depending upon the retinal surgeon’s discretion. The gas bubble goes away in two to eight weeks, depending on the type of gas bubble used.
The most common side effect of macular hole surgery is the development of a cataract in patients who have not already undergone cataract surgery. The chance of developing a cataract is over 80 percent due to the surgery and gas bubble. Cataract surgery is typically performed after the gas bubble has dissipated to achieve the best possible vision.
This series of macular hole articles was reviewed by Dr. Antonio Capone 2023.