Macular Hole

Macular Hole

This is a condition where a small hole forms in the center of the retina, leading to distortion and a small blind spot centrally that blocks clear vision. It happens when the vitreous gel starts to pull away from the retina in the back of the eye (as it normally does with age). Most of the time the vitreous successfully separates into a posterior vitreous detachment, but in rare cases it remains adherent centrally in the macula. If the vitreous pulls on the macula hard enough, it can create a hole. It is most commonly seen in females aged 40-70, but not exclusively. Once one eye develops a hole, the other eye has a 10% risk of the same process (if the vitreous has not already detached successfully).

A scan showing retinal layers with upturned edges indicating a macular hole

Macular holes are repaired with vitrectomy surgery. The vitreous gel is removed, scar tissue around the macula that holds the hole open are peeled, and a gas bubble (rarely silicone oil) is placed in the eye. The success rate of closing the hole is over 90% in typical cases, but the hole does not close perfectly and some permanent residual distortion and blind spots are often noted. Full visual recovery often takes more than 3 months.

Most importantly, face down positioning is needed for several day after surgery to allow the surface tension of the gas bubble to close the hole successfully. Positioning is done for 50-55 min per hour with a short time to stretch out the neck in between. Sleeping can be done either face-down or on either side with the nose pointed towards the pillow. Specialized positioning equipment can often be rented (and covered by insurance) to assist in the process. Please ask the surgical coordinator.

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