MACULAR HOLE

A macular hole affects the central retina and if left untreated results in complete central visual loss. 

It tends to affect people over 60 years old but can affect younger people after ocular trauma or severe myopia.

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The hole forms from pulling by the vitreous gel on the center of the retina. Macular hole formation occurs in stages beginning with a cyst (stage 1) and ending with a full thickness hole with separation of the vitreous gel (stage 4). Reading and detail vision is ultimately lost

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Macular holes are more common in women and may be more common in family suggesting a genetic predisposition. There is a 10% chance one may develop in the fellow eye, often months to years after the first eye has been affected.
 

Surgical treatment using microincision vitrectomy techniques allows closure of macular hole in 90% of cases with improvement of visual acuity. 

Surgery requires a gas bubble to be placed, which takes approximately 2 weeks to dissolve away. The vision improves steadily after the gas has disappeared. 

Patients may need to posture after surgery in a particular position, but often extended face-down posturing can be avoided with modern techniques.

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The best results are obtained when surgery is performed within 6 months. As with most medical problems the earlier it is treated, the better. Macular hole surgery is not urgent (does not have to be repaired today), but should be repaired within a month or so if possible, for the hole can enlarge with time.  Best chances of visual recovery occur when the hole has been present for less than six months.

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