MACULAR HOLE

The macula is the part of the retina that allows fine detail vision.  It corresponds to the centre of your visual field.

A macular hole can develop leading to reduced vision.

Causes:

  • Idiopathic:  This means no predisposing cause and is the most common scenario.
  • Trauma
  • Sungazing
  • Severe myopia:  extreme short-sightedness

Idiopathic is by far the most common.

Mechanism:

It is thought that macular holes result from tractional or pulling forces exerted by the vitreous.  The vitreous is a jelly like material that fills the cavity of the eye and is attached to the macula.

Investigations:

OCT:   This device takes “snapshots” of the macula.  It will provide high resolution accurate images of your macula and give a 3D image of the hole.  It will also be used after surgery to determine if closure of the hole has been successful.

Treatment:

This involves a procedure called Vitrectomy and gas with posturing:

(a)  Vitrectomy – Here the vitreous is removed at surgery.  It is performed usually under local anaesthetic and as a day procedure.  This relieves traction on the macula.

(b)  Gas – This is injected into the eye after the vitreous has been removed.  It helps to close the macular hole.  While the gas is present, patients will not be able to travel by air.

(c)   Posturing – For several days after surgery patients will be required to position face down.  Special pillows to help this process are available.  This positioning ensures that the gas bubble is in the optimal position for successful closure of the hole.

 

OUTCOMES:

With surgery, closure rates are great than 95%.  Best visual results occur if the surgery is performed within 6 months.

In about 15% of patients, the other eye will be affected.

Click here for Macular Hole Fact Sheet