Macular Holes

The eye is full of a jelly-like material, called vitreous. As people age, the vitreous gel in the eye shrinks and pulls away from the retina. This is a natural part of aging and usually this occurs without consequence. However, in a small number of cases, the vitreous gel pulls strongly enough on the retina that it causes a hole. Unfortunately, this hole is usually located directly over the center of the vision (the macula), which results in blurring and distortion.

Symptoms

A macular hole can cause blurred or distorted vision. A hole that goes all the way through the macula can result in significant loss of central vision. There is no pain associated with a macular hole.

Diagnosis

An ophthalmologist who suspects a macular hole may:

Perform a dilated pupil examination to see the inside of the eye with an ophthalmoscope.
Take pictures or use optical coherence tomography (OCT) to image the retina

Treatment

Macular holes can be successfully treated with surgery.

This involves removing the vitreous gel and injection of gas inside the eye. The gas acts as an internal, temporary bandage that holds the edge of the macular hole in place as it heals.
In order to maximize the effect of the repair, the patient is usually required to remain in a face down position for one week postoperatively to allow the bubble to press against the macula and seal the hole.
Over the period of two to six weeks, the bubble will gradually be reabsorbed as the vitreous cavity refills with a naturally produced fluid.