Macular Hole

A macular hole forms when there is traction on the macula from the vitreous that pulls the center of the macula enough to form a hole in the center of the vision.

What is a Macular Hole?

The macula is the center of your retina. It is responsible for your straight ahead vision. While reading the print on this page, you are using your macula. The cornea and lens in the front of your eye focus the image of these words onto your macula. The macula converts the light from the image on this page into a neurological signal that is processed by your brain. Since the very center of the macular is the thinnest part of the retina, it is also relatively weak. Some patients have an abnormally tight attachment between the vitreous gel that fills the eye and the center of the macula. When the vitreous gel contracts with aging, or after an injury, these people can develop a macular hole. Interestingly, 90% of macular holes occur in females. The reason for the female predilection for macular holes is unknown.

Macular Hole Stages

Macular holes are staged from 0 to 4. A stage 0 macular hole is not visible. It only shows up as a vitreous attachment at the center of the macula with optical coherence tomography scanning. Most eyes with stage 0 macular holes never develop a symptomatic macular hole. A stage 1 macular hole is not a full thickness macular hole. It forms when the center of the macula is tented upward from traction but a hole has not formed. Less than half of eyes with stage 1 macular holes develop a full thickness macular hole. Most of these eyes heal on there own. Stage 2 macular holes are small full thickness macular holes. Twenty percent of these holes will heal on there own. Most do not. Stage 3 macular holes are larger macular holes where the vitreous is still attached to the hole. Stage 4 macular holes are larger macular holes where the vitreous is not attached to the hole.

Macular Hole Spontaneous Closure

Small macular holes (Stage II) have about a 20 percent chance of spontaneously closing. The animated image with this text shows a macular hole that closed without surgery. Since macular hole surgery is never an emergency, it is sometimes worthwhile waiting a short time to see if a small macular hole will close on its own. When macular holes abort, or spontaneously close, the vision often returns all the way to normal over the course of about a year. There is often a small piece of tissue that can sit in front of the fovea, a pre-foveal opercula, that can block the vision. In the accompanying image, the patient took over a year for the pre-foveal opercula to pull free of the macula.

Macular Hole Surgery

Surgery is successful in closing macular holes that are less than 6 months old nearly 100 percent of the time. About 90 percent of macula holes close with one surgery. Some require multiple surgeries. Once a macular hole is closed, the vision improves some in 80 percent of eyes, a lot in 50% of eyes (to 20/40 or better), and to nearly normal in 10% of eyes (20/20). Even eyes with normal vision usually have some distortion in the vision for at least a year from the surgery. The risk of surgery is mostly that of retinal detachment (2%-10%), infection (0.01%) and bleeding (0.1%). Cataracts from in most eyes undergoing vitrectomy for any reason in patients over 50. Without surgery macular hole patients usually only lose the very center of their vision. The side vision stays good. Many older patients (85 and up) with a second good eye may decide not to have surgery for macular hole. To repair a macular hole, the surgeon first removes all the vitreous from inside the eye. This relaxes the edges of the macular hole. Many surgeons also do an internal limiting membrane peel further relaxing the edge of the hole. Then the patients eye is filled with gas. The gas pushes the hole closed like a draw bridge. In order for the gas to push on the hole, the patient must look toward the center of the earth after the surgery. Many different surgeons recommend different regimens. Most require a few days to a week of 90% face down positioning. There are pillows and message tables available in most cities for rent if patients want the extra help.

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Most patients with macular hole choose to have surgery. Macular holes over 6 months old can be closed, but the visual acuity results are not as good as they are for fresh holes. Even old holes, five to 10 years old, can be closed with surgery. In these situations there is about a 50% chance of improving vision.

Dr. Pautler's Blog on Macular Hole

Video Macular Hole Surgery without ILM Peel

This patient had a two month history of vision loss from a macular hole. The pre-operative OCT scan showed a stage II macular hole with a diameter of about 250 microns. The scan did not show a taught internal limiting membrane. This surgery is done with a short acting sulfur hexafluoride gas and no internal limiting membrane peel. The patient positioned for a week after surgery (Strict for 3 days). The hole closed and the vision has improved to 20/30 at 2 months.



Video Macular Hole Surgery with ILM Peel

Macular hole surgery in a patient with a stage 2 macular hole. The internal limiting membrane is peeled. A short acting gas was used (sulfur hexafluoride) and vision was 20/50 1 week after surgery. This surgery was done 1 month ago. Vision at 1 month visit was 20/40.



Macular Hole NEWS

Below are current articles from a Google News Feed on Macular Hole


Macular hole surgery: an analysis of risk factors for the anatomical and functional outcomes with a special emphasis ...
Dove Medical Press
Purpose: The aim of this study was to evaluate risk factors for the anatomical and functional outcomes of macular hole (MH) surgery with special emphasis on the experience of the surgeon. Methods: A total of 225 surgeries on idiopathic MHs (IMHs) ...


Full-thickness macular hole formation following anti-VEGF injections for neovascular age-related macular degeneration
Dove Medical Press
Purpose: Macular hole (MH) is part of a group of age-related degenerative diseases characterized by pathology of vitreomacular interface. Similarly, neovascular age-related macular degeneration (nAMD) affects older patients and is a leading cause of ...


Patient adherence to the face-down positioning after macular hole surgery
Dove Medical Press
Purpose: To determine adherence to face-down positioning (FDP) among patients who underwent vitrectomy and gas tamponade for macular hole (MH) repair. Method: A total of 69 patients (37 females and 32 males) who underwent primary vitrectomy for MH ...


The Herald

After rough road, Cats' Verkamp gains new focus
The Herald
After the initial reconstructive surgery April 11 to repair that fracture, Verkamp underwent another operation a month later to correct what doctors termed a traumatic macular hole in his retina, which was discovered about a week after he took the ...


Vital Art and Science Announces License Agreement with ...
Business Wire (press release)
Vital Art and Science, LLC today announced that it has signed a license agreement with Genentech, a member of the Roche Group, for the use of Vital Ar.

and more »

ETHealthworld.com

OCT is a truly transformative medical technology
ETHealthworld.com
This non-invasive imaging test today is useful in diagnosing many retinal conditions like diabetic retinopathy, macular hole, macular pucker, macular edema, age-related macular degeneration, central serous retinopathy, and vitreous traction. It is also ...


Retinal Drugs and Biologics Market: Global Industry Analysis, Size, Share, Growth, Trends, and Forecasts 2016–2024
Digital Journal
Depending on the types of conditions, the global market is categorized into diabetic retinopathy, macular hole, age-related macular degeneration, and ocular inflammatory disease (uveitis). The different distribution channels of the retinal drugs and ...


ModernMedicine

ILM peeling with retinal staining aids macular hole closure
ModernMedicine
Take-home: Peeling of the internal limiting membrane with staining of retinal tissues might help macular hole closure and resolve retinal schisis. Dr. TezelPerforming a vitrectomy might accomplish more than meets the eye. Recent observations indicate ...


'Real-world' ocriplasmin macular hole closure rates lag trials
ModernMedicine
Ocriplasmin (Jetrea, ThromboGenics) may achieve lower macular hole closure rates than in trials, new British and Irish data suggests. Also, “the incidence of adverse events was greater than previously reported,” wrote RJ Haynes of Bristol Eye Hospital ...


Retinal Drugs And Biologics Market Value Chain and Forecast 2017-2027
LANews By Abhishek Budholiya (press release) (blog)
The disorders related to retinal health include age-related macular degeneration, diabetic retinopathy, infectious retinitis, macular edema, macular hole, retinoblastoma, retinal degeneration, retinoschisis and uveitis etc. There are various types of ...


Medscape

Flap Technique Effective for MHRD
Medscape
The inverted internal limiting membrane (ILM) flap technique results in significantly better vision in patients with macular hole-associated retinal detachment (MHRD) and highly myopic eyes when compared with ILM peeling alone, a small retrospective ...


WhaTech

Research delivers insight into the optical coherence tomography market
WhaTech
Based on application, the market is segmented into age-related macular degeneration, central serous retinopathy, diabetic retinopathy, macular edema, macular hole, macular pucker, vitreomacular traction, pre-retinal membranes, others. On the basis of ...

and more »

Small-gauge vitrectomy associated with likelihood of successful recurrent macular hole closure
Healio
FORT LAUDERDALE, Fla. — It is unclear if the use of small-gauge vitrectomy to treat macular holes results in less incidence of recurrent macular holes, but the procedure has a high likelihood of success in treating recurrent macular holes, according ...


WBIR-TV

ETTAC provides life changing services
WBIR-TV
"It tore a hole in the macular of the right eye. They did surgery and they could not get it to work right," she said. She is legally blind but can see a little out of her left eye. But not well enough to drive or read or work on her carving. "I would ...


Autologous retinal transplantation used to treat macular hole
Healio
Autologous retinal transplantation should be considered for patients who have several failed prior procedures for macular hole or when the internal limiting membrane (ILM) has already been peeled and a free or inverted ILM flap is not an option, Tamer ...


Bel Marra Health

Macular hole causes, symptoms, treatments, and difference from macular degeneration
Bel Marra Health
Macular hole is an eye condition that typically appears in people over the age of 60, but it is not the same as the much talked about eye disorder macular degeneration. It's important to understand what makes them different, especially if you have a ...


ModernMedicine

Considering body posture after macular hole surgery
ModernMedicine
It is the responsibility of surgeons to provide patients the opportunity for their best chance at success, and with that in mind, retina surgeons should know that while macular hole surgery can be effective without face-down positioning, the highest ...


Dove Medical Press

Successful closure of treatment-naïve, flat edge (Type II), full-thickness macular hole using inverted internal ...
Dove Medical Press
Objective: The objective of this study was to present the outcome of the internal limiting membrane (ILM) peeling flap technique for a treatment-naïve, flat edge (Type II), full-thickness macular hole (MH). Methods: A 52-year-old man presented with ...


Inverted flap technique yields high success rates
ModernMedicine
Chicago—The inverted internal limiting membrane (ILM) flap technique is not only a safe and effective procedure for treating macular holes, but compared with conventional ILM peeling, it is significantly more effective for achieving macular hole ...


Medscape

Ropivacaine: Less Pain, Hemorrhage Risk During Vitrectomy
Medscape
The best intraoperative peribulbar anesthetic during vitrectomy is ropivacaine (1%) compared with bupivacaine, lidocaine, and a solution of bupivacaine and lidocaine, according to a randomized, double-blinded trial published online February 7 in the ...


Common vitreo-macula conditions
Trinidad & Tobago Express
... continues to shrink, its adhesion to the macula may release and the VMT may resolve without need for treatment (approx ten per cent of cases). In a number of patients, the VMT will increase and may produce a macula hole. The management of macula ...


Identifying common macular conditions with OCT
ModernMedicine
As baby boomers age, clinicians need to be comfortable with diagnosing common macular conditions and interpreting optical coherence tomography (OCT) findings. OCT is a diagnostic imaging technique that allows for the qualitative (morphology and ...

and more »

New theory may address idiopathic macular holes
ModernMedicine
Take-home message: The evaluation of multiple optical coherence tomography images supports the combined tractional-hydration theory of idiopathic macular hole formation, progression, and closure. By Laird Harrison; Reviewed by Ronald C. Gentile, MD.


OCT screening before cataract surgery: Three must-know diseases
Healio
With the advent of OCT, we can examine the retina, particularly the macula, in high resolution before cataract surgery. This is important because the cataract may not be the sole cause of visual impairment, and patients need to have appropriate ...


Study Evaluates Use of Whole Blood Followed by Brilliant Blue Versus Conventional Brilliant Blue for Staining of ILM ...
Eye Doc News
To compare the structural and functional outcome of use of autologous heparinized whole blood before staining internal limiting membrane with brilliant blue (BB) versus conventional BB–assisted macular hole surgery, sixty eyes of 60 patients were ...


Medscape

Drawn to Innovation? Then Set Your Sights on Ophthalmology
Medscape
For example, excellent medical and surgical interventions are available today that in many circumstances can improve patients' visual function, such as cataract surgery, corneal transplantation, macular hole closure, and retinal detachment repair ...


WABI

Healthy Living: Shift in Retina Surgeon Practice
WABI
Retina specialists have progressively shifted away from 20-gauge vitrectomy toward the use of either 23 or 25 gauge vitrectomy in the majority of total vitrectomy surgeries. The introduction of microincision sutureless vitrectomy systems and associated ...

and more »

The Missoulian

Prep Extra: Miltko overcomes scary eye injury to lead Loyola lineup
The Missoulian
Eventually the swelling came down and the doctors could make a more accurate diagnosis. “I had a macular hole in the back of my eye,” Molly explained. It's as gruesome as it sounds. While normally seen in patients whose eyes have degenerated over time, ...


WebMD.Boots.com

Macular hole
WebMD.Boots.com
A macular hole is a small gap which opens up in the macula, found at the centre of the retina, which is responsible for our sharp and detailed central vision. A macular hole affects the vision you use when looking directly at something, like a book or ...


Wilkes Barre Times-Leader

Dr. Joshua Hedaya joins Eye Care Specialists as retina specialist
Wilkes Barre Times-Leader
He spent two additional years in vitreoretinal surgery and uveitis subspecialty training at University of California, San Diego under the direction of Dr. William Freeman, an internationally recognized pioneer in macular hole surgery, HIV-related ...

and more »
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