Macular Holes

What Causes a Macular Hole?

The central part of the retina is called the macula. The gel-like substance inside the eye is called the vitreous. The vitreous is attached to the macula, and it separates normally with age. However, in some cases, the vitreous exerts forces on the macula. This causes it to develop a central defect called a macular hole. This results in distorted, grey or absent central vision.

What Testing Might be Done?

Your doctor will examine your eye and may obtain photographic and OCT tests to determine the presence and extent of damage from a macular hole.

How is a Macular Hole Treated?

An outpatient microsurgical procedure called a vitrectomy is the mainstay of treatment. The vitreous is first removed, and then a thin tissue layer is usually delicately removed from the surface of the macula. The eye is then filled with a special gas bubble that dissolves over three to six weeks. You will need to maintain a facedown position for about a week to gently compress the tissues back together and allow the hole to close. An office procedure involving an eye injection of a recently FDA-approved drug called Jetrea may be an alternative to surgery.

Can the Gas Bubble Put in My Eye at the Surgery be Harmful?

A rapid increase in altitude can cause a dangerous rise in eye pressure, so travel in the mountains or by airplane must be avoided. One should also avoid nitrous oxide gas commonly used during dental procedures. Also, until the bubble is gone, a person who has not had cataract surgery should avoid lying flat on the back to sleep.

What Can I Expect for My Vision After Vitrectomy?

Vision recovery often depends on how long the hole was present before surgery and may not return entirely to normal. We do expect vision to be vastly superior to what it would be if the problem was ignored. Many patients will eventually need cataract surgery and adjustment of their glasses to obtain their best vision after macular hole surgery.

What if I Cannot Remain in a Face-down Position After Vitrectomy?

If you cannot remain in a face-down position for the required period after surgery, vision recovery may not be successful. People who are unable to remain in a face-down position for this length of time may not be good candidates for a macular hole surgery. However, there are a number of devices that can make the “face-down” recovery period easier on you. Discuss these with your doctor.

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