A Macular Hole is an abnormal opening in the retina in the center of the macula. A macular hole is small, but because it occurs in the most sensitive area of the retina, it can cause substantial loss of vision. Macular holes occur more commonly in females in their 60’s and 70’s, and occasionally affect both eyes. Abnormal traction, or pulling by the vitreous gel creates the macular hole. Rarely, they are the result of trauma.

Symptoms
Symptoms include decreased central vision, ranging from 20/80 to 20/400. Because of the location of the retinal hole, patients describe a central blind spot. Peripheral vision remains normal. Without treatment the majority of patients with a macular hole will experience progressive loss of central vision after the hole develops.

Treatment
The only treatment for a macular hole is surgery. Eye drops, medications or glasses will not correct the loss of vision. During vitrectomy surgery, the vitreous gel is removed, including a delicate membrane frequently present which is pulling or holding the macular hole open. The surgery is performed under the operating microscope using very fine instruments. An absorbable gas bubble is left in the eye to seal the hole. Removing the vitreous is not harmful to the function of the eye. Vitrectomy surgery is an outpatient procedure performed under local anesthesia. After surgery it is crucial for the patient to maintain a face down position for one week. This keeps the bubble in constant contact with the macular hole, which will promote hole closure.

Until recently, macular holes were untreatable. Advanced microsurgical techniques combined with patient cooperation now allow for very high rates of surgical success. Most patients experience a significant improvement in vision following successful macular hole repair.

Face Down Position

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