What is a Macular Hole?

Think of the retina as a target with the center portion as the “bulls-eye”. This “bulls-eye” is the MACULA, the region of the retina that is used for reading and seeing fine detail. When a hole develops in the macula it is called a MACULAR HOLE.

What causes a Macular Hole?

A jelly-like substance or VITREOUS fills the eye ball. In a young person, the vitreous has the consistency of jello. As the person ages, the vitreous tends to become less like jello and more like liquid. Between the ages of 50 and 70 years, this vitreous often starts to separate from the retina and when that happens, the vitreous sticks to the macula, exerting traction and causing a MACULAR CYST. Eventually, this cyst ruptures, causing a macular hole. The body attempts to heal this hole but in doing so, develops scar tissue around the hole which causes it to open further. Think of the scarring process as a reversed “purse string” effect.

Treatment for Macular Holes:

Repair of macular holes is accomplished by surgery that involves an incision into the eye and removal of the diseased vitreous and scar tissue. Gas is injected into the eye to close up the hole. The gas acts as a band-aid, holding the hole closed while the eye grows a new membrane over the top of the hole to seal it.

Macular hole surgery has a 85% success rate, with success being defined as closure of the macular hole and improvement of near vision to 20/50 or better. There is a 50% chance of developing a cataract in the eye and a 1 % chance of a retinal tear or detachment.

Following the surgery, the patient must remain in a face down position to keep the gas bubble up against the macular hole while it is healing.