A Macular Hole is an abnormal opening in the retina on 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 most commonly in females in their 60's and 70's and occasionally affect both eyes.  The cause of macular holes in unknown, although they are sometimes the result of trauma.

Symptoms of a Macular Hole

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

Treatment of a Macular Hole

The 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 in a face down position for 1 to 2 weeks.  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.

Macular Hole Before Vitrectomy

Vitrectomy for Macular Hole

Macular Hole After Vitrectomy (same eye)