Macular Hole

I. What is and what causes a Macular Hole?
The macula is the most sensitive central portion of the retina, used for fine reading vision. A macular hole is a full-thickness defect in the center of the retina. It is probably caused by the pulling of the vitreous gel on the thinnest central retina or macula, which then tears. The break in the macula expands just like a run in a nylon stocking might enlarge. As the hole enlarges, fluid usually passes under the retina, which in turn causes enlargement of the blur. Eventually, the process stabilizes. It very rarely improves if left untreated. It does not lead to total loss of vision, but usually leads to the level of legal blindness in the affected eye.

Macular Hole (fluorescein angiogram) Click to Enlarge

Macular Hole (fundus photo) Click to Enlarge

Macular Hole before surgery (OCT) Click to Enlarge

Macular Hole after surgery (OCT) Click to Enlarge

II. How is a Macular Hole treated?
Vitrectomy is now the standard treatment for most macular holes. Nearly all of the vitreous gel is removed from the eye. A large gas bubble is placed in the eye. After surgery, the patient is asked to look down until the bubble goes away all by itself. The bubble flattens the edge of the hole, and in 70-100% of patients, leads to disappearance of the macular hole. If the hole disappears, 85% will experience vision improvement.

Depending on the level of vision prior to surgery, 60-85% will achieve driver's license level of vision after surgery. The surgery does not work in every patient. The factors that predict success are most likely duration of symptoms, size of the hole, and baseline visual acuity. Discuss your prognosis with your doctor.

Retinal Disorders

Diabetic Retinopathy
Age-Related Macular Degeneration
Retinal Vein and Artery Occlusions
Macular Hole
Macular Pucker
Retinal Tears and Detachments
What is Fluorescein Angiography?
What is Photodynamic Therapy?
What is ICG Angiography?
What is optical coherence tomography?

Back to Top