What is a macular hole?
A macular hole is a small break occurring in the centre of the retina. The centre of the retinaThe retina is the thin layer of nerve tissue lining the back of the eye that detects light and sends information to the brain to allow us to see. is the macula, and this area is responsible for precise vision, allowing us to appreciate fine detail, contrast, and colour.
What causes a macular hole?
As part of the natural ageing process in the eye, the vitreous gel gradually shrinks and pulls away from the retina. This process creates abnormally high forces on the macula. If these forces are strong enough, they create a macular hole.
Other factors also increase the chances of developing a macular hole:
- High degrees of short-sightedness
- Retinal detachment
- Prior eye trauma
- Macular swelling from diabetes or macular degeneration
What are the visual symptoms of a macular hole?
Vision with macular hole
A macular hole causes blurry vision or a distinct darkish spot in central vision. This affects reading, driving and performing tasks that require seeing fine details. A macular hole does not lead to a complete wipe-out of vision as it only affects central vision. The peripheral (i.e. side) vision will remain intact and unaffected.
It is possible that both eyes are affected by macular holes.
Can a macular hole heal on its own?
Early macular holes may resolve on their own, over a course of a few months. However, for the majority of macular holes, surgical treatment to close the macular hole is required in order to improve vision.
Every patient with a macular hole requires assessment by an eye specialist to understand the natural course of the disease and potential treatment options.
Speak to an eye specialist in Singapore today.
How do retinal surgeons treat macular holes?
Macular holes are treated with a micro-incision surgical procedure called vitrectomy that usually takes 1 hour. This procedure can be performed under local or general anaesthesia.
During vitrectomy surgery, the vitreous gel is removed, which relieves the tension caused by the gel tugging on the macular hole. Tension around the macular hole is also relieved. For larger or longer-standing macular holes which are more difficult to close with these strategies alone, your retinal surgeon may additionally use membrane or lens capsule grafts to plug the hole. A gas bubble is placed in the vitreous cavity. After the surgery, the bubble remains in contact with the macula to facilitate closure of the macular hole.
A few days of face-down head positioning is usually required after macular hole surgery, which will allow the bubble to support the macula and assist in hole closure. This is usually the hardest part of the post-operative recovery!
If a gas bubble is placed in your eye, you must not travel by air or travel to high altitude locations until the gas bubble is completely gone. This is because the gas bubble will expand in size and can lead to increased pressure inside the eye and cause visual loss.
Silicone oil may also be used in lieu of gas, if there are specific reasons to, i.e. if you need to travel by air very soon after surgery, or difficulty with maintaining a face down position.
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MBBS, MMed(Ophth), MRCSEd,
FRCSEd, FRCOphth, FRCS(Glasg), FAMS, FRCS(Canada)
Subspecialty: Cataract surgery, general ophthalmology, macular degeneration, diabetic eye disease, vitreoretinal surgery, uveitis