Macular hole

A macular hole reduces visual acuity. Recovery without surgery is rare. Make an appointment with one of our experienced surgeons today!

What is macula (yellow spot)?

The macula is the central area of the retina. It is the place where the light is focused. This part of the retina contains the greatest concentration of photoreceptors and, hence, allows us to detect details. The fovea (the central part of the macula) is the most important part of the retina.

Macular hole

Macular hole: symptoms

A macular hole significantly reduces central vision. Visual acuity often reduces to 5/10, sometimes to 1/20 even. As the patient won’t be able to discern details, reading will become a thing of the past. The patient won’t become blind but will be partially sighted.

Macular hole: cause

The cause of a macular hole is associated with the vitreous and the posterior hyaloid membrane. As we age, the vitreous shrinks and the posterior hyaloid membrane may come away from the retina. Usually, this will not affect the retina but sometimes a small hole can appear in the macula.

Prognosis

A macular hole that is left untreated has a poor outcome. Spontaneous recovery is rare and visual acuity will often reduce to 5/10, at times to 1/20 even. As the patient won’t be able to discern details, reading will become a thing of the past. The patient won’t become blind but will be partially sighted.

Macular hole: treatment

  • Treatment

    Diagnosis

    • A macular hole that is left untreated has a poor outcome. Spontaneous recovery is rare.

      The need to perform surgery will depend on:

      • The stage of the hole: from stage 2, surgery is indicated.
      • Visual acuity: as long as a patient’s eyesight is still good it’s best to hold off for a while.
      • The length of time the hole has been present: the longer the hole has been present the smaller the chances of the hole closing after surgery and the poorer the eyesight.
      • Other factors such as age, health, bother to the patient.
    • Treatment

      The surgical procedure for a macular hole is a vitrectomy. Without surgical intervention, eyesight will deteriorate quickly and irreversibly.

      The first step in a vitrectomy is to create 3 microscopic incisions in the eye’s sclera (= white outer layer of the eyeball). These incisions are required for the surgeon’s instruments. Via the first incision, the eye is infused with water to ensure that it retains its shape during surgery. Next, the endolight is inserted via the second incision so that the surgeon can see everything clearly. The vitrectomy probe is inserted via the third incision. This probe is a tiny tube that cuts away and suctions microscopic particles of the vitreous. The vitreous that has been removed is replaced with clear water. Blue dye is used to clearly visualise the inner layer of the retina (internal limiting membrane or ILM). Next, this membrane is removed by means of minuscule tweezers. This procedure is known by the name of ‘peeling’. By removing this membrane or ILM the forces that created the macular hole are eliminated and the hole will close. To promote closure, gas or silicone oil will be injected into the eye. The choice between gas and silicone oil will depend on the size of the macular hole. The gas bubble will gradually disappear of its own accord and after about two weeks you will be able to see more clearly again. As long as there is any gas left in the eye you are not allowed to fly or spend time at high altitudes (mountains). If silicone oil is used, the oil will have to be surgically removed after a number of weeks or months.

    • After surgery

      Often the eye will be swollen and feel gritty. There will be some redness and the eye will be prone to tearing. To prevent inflammation, anti-inflammatory drops will need to be applied. It is quite possible that the patient may have to adhere to the face-down position for a number of days after surgery.

    • Recovery after surgery

      In most cases (95 %) the macular hole will close successfully. Unfortunately, anatomic recovery does not always improve visual acuity. Recovery of the patient’s eyesight will depend on the length of time the macular hole was present prior to surgery and on his initial eyesight. It may take quite some time, up to a number of months even, before eyesight is fully restored. On average, visual acuity will improve by 20 to 30 % once the macular hole has closed. This is why it is extremely important not to put off surgery for too long. In some cases eyesight will not improve in spite of the fact that the hole has anatomically closed. In other patients, eyesight will recover quasi completely.

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