Macular Hole Treatment

The macula is attached to the retina and is responsible for the central vision. When the vitreous gel moves or shifts due to age or trauma, the macula is pulled, forming a hole in the macula. When the hole is full-thickness (meaning a complete tear in the macula), the result is lost or distorted vision. The only treatment is surgery to repair the hole.

Treatment

• Early detection of a macular hole will increase the chances of restoring the greatest amount of lost vision. The more time that goes by, the larger the hole will become, leading to a more difficult condition to correct.

  The procedure for treating macular holes is called vitrectomy. In this procedure, portions of the vitreous are removed. The vitreous is a thick, transparent liquid that makes up most of the eye and gives the eye its shape. Various other parts of the eye can be removed, such as the perimacular traction, ILM, and epiretinal membranes, to increase the chances of success. These parts of the eye may pull or continue to pull on the macula, preventing the hole from closing.

  Once the eye is examined for peripheral retinal tears (other holes and tears in the retina), the fluid in the vitreous cavity is extracted and exchanged with air in order to remove the moisture. Then the air is replaced with a non-expansive, long-acting gas. The purpose of this gas is to push on the macula while the patient looks down, so the hole can heal.

  In a sense, the procedure takes the pressure off the macula by removing whatever seems to be pulling it to the point of tearing (whether it be the vitreous or peripheral parts of the eye) and by supporting the macula with gas, so that it can heal.

  It is recommended post-op and for the days following the procedure that the patient utilizes face-down positioning to increase the chances of success. The procedure has a high success rate.

Post-Treatment

• Because the procedure can lead to complications, regular examinations are recommended. Complications include retinal detachment, retinal tears, hole enlargement, macular light toxicity, postoperative pressure elevation and cataracts. The use of medicine to quicken hole-closure time has not proven effective and is therefore generally not implemented.