What is a Macular Hole?

A macular hole is a discontinuity of the central neurosensory retina. It results in a loss of central vision and distortion of vision. The retina is the inner lining of the eye which is responsible for light being transmitted to the optic nerve. The centre of the retina is called the macula. This is where the best retinal cells are located and where our sharp vision as well as a large proportion of our colour vision is produced. As the macula is affected it has a significant impact on central vision. If left untreated it will result in a loss of vision in the eye.

This condition until thirty years ago was considered a blinding condition until technological advances involving surgery was developed to treat it. Today up to 95% of macular holes can be closed and vision regained with a day case operation.

The presence of a macular hole can be detected by slit lamp examination and measured using an Optical Coherence Tomography (OCT) scan. This is a non-invasive imaging technique which provides a cross-sectional image of your retina. This can be used to stage and grade the type of macular hole present.

What Causes a Macular Hole?

The most common cause of a macular hole is related to the aging process of the vitreous. As time goes on the vitreous or jelly inside your eye starts to shrink. This process can result in the back surface of the vitreous moving away from the retina in what is known as a posterior vitreous detachment.

In some people the vitreous is very adherent to the macula and can cause the macula to be pinched upwards. When the pinch of the vitreous is released, it leaves a hole in the centre of the macula. It is more common in females and people who are short sighted or have had previous trauma to the eye.

Macular Hole Eye Wales

How Would  Macular Holes Affect my Sight?

The earliest things you might notice are distortion, blurred vision, straight lines appearing wavy and reading becoming difficult. Some people notice a pinching in their vision. Later on you may notice a significant loss of central vision.

When Should I have Macular Hole Surgery?

Almost all macular holes will worsen over time if left untreated, so early surgery will give you a better chance of long-term visual success. Even if you have very few symptoms, we may recommend that you have surgery to prevent further deterioration and to give you the best chance of long-term success. Macular holes which have been present for over a year have a lower chance of closing.

Today up to 95% of macular holes can be closed, and vision regained with a day case operation. 

The procedure that is used to treat macular holes is called a vitrectomy. This requires the use of keyhole surgery in the eye to remove the vitreous. The superficial layer of the retina is then peeled around the macular hole to give the retina more elasticity. A gas bubble is then injected into the eye. This bubble pushes the retinal edges of the hole together and effectively causes it to close. 

Depending on the size of the hole you may be required to keep yourself in a face down position for up to five days after the surgery. This gives the best chance of the macular hole closing, as it pushes the gas bubble onto the central macula. Post operative drops are required for a month after surgery

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