A macular hole typically is defined as a break or small hole in the macula of the eyeball. The macula is the pigmented spot in the center of the retina responsible for providing sharp, acute central vision. The location and size of a macular hole on the retina generally determine the severity of visual deficit. If not treated, this condition could turn into a detached retina. A detached retina often threatens sight and typically is considered a medical emergency.
Macular holes generally are related to the aging process and affect people who are more than 60 years old. Symptoms may include distorted and blurry central vision. Typically, in the early stages of macular holes, patients often experience only slight blurriness or distortion in their central vision. Straight lines may take on a bent or wavy appearance. Performing routine tasks and reading often become difficult.
Causes of a macular hole might include nearsightedness, retinal detachment, diabetes, and eye injury. If a macular hole is present in one eye, there often is a 10- to 15-percent chance that another macular hole will present itself in the other eye during the course of a lifetime. Macular holes usually begin gradually and the patient often is unaware of the condition.
Sometimes, macular holes may seal themselves, however surgical intervention may be necessary to improve vision in many cases. The surgical procedure is called a vitrectomy. Vitrectomy is removal of the ocular vitreous gel to prevent it from tugging on the retina, and replacing it with a combination of gas and air. This combination of gas and air forms a bubble, which acts like a bandage to keep the edges of the macular hole in place while it heals. Macular-hole surgery usually is done in an outpatient setting with a local anesthetic.
After surgery, patients usually have to keep their face down for one or two days. In some cases, they may need to maintain this position for two to three weeks. The face-down position helps the bubble exert pressure against the macula, therefore allowing it to be reabsorbed back into the eye. This usually will seal the hole and allow the cavity to refill with eye fluids.
Risks of a vitrectomy include cataract formation, infection, or detached retina. Patients usually are advised not to travel in an airplane because fluctuations in air pressure might cause the air bubble to expand, increasing intraocular pressure. Visual improvement following surgery varies from person to person. Individuals who have had a macular hole for six months or less typically have a more favorable chance of recovering lost vision.