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


ModernMedicine

Clinical imaging of macular holes
ModernMedicine
The term “macular hole” was first used to describe a partial- or full-thickness hole in the foveolar area. The area is susceptible to degeneration and hole formation because of its extreme thinness, avascularity, and lack of support by the neural and ...


Quantifying metamorphopsia with M-CHARTS in patients with idiopathic macular hole
Dove Medical Press
Patients and methods: The records of 22 eyes of 22 patients with a full-thickness macular hole who underwent pars plana vitrectomy and ILM peeling were reviewed. All patients underwent a complete ophthalmic examination including spectral-domain optical ...


Dove Medical Press

Long-term evaluation of spontaneous release of epiretinal membrane and its possible pathogenesis
Dove Medical Press
To investigate the pathogenesis of ERM, tryptase activity in vitreous, which plays a role in tissue fibrosis and remodeling, was measured in patients that underwent a vitrectomy for ERM, macular hole, and proliferative diabetic retinopathy (PDR ...


Global Optical Coherence Tomography Market Details by Instruments, Method, Application & End User, Forecast to ...
Medgadget (blog)
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 »

Paracentral retinotomy facilitates closure of large, resistant macular hole
ModernMedicine
Most macular hole surgeries end successful with achievement of hole closure. However, there is a small percentage, ranging from 3% to 10%, of large macular holes that will not close despite peeling of the internal limiting membrane (ILM) and ...


Refractive changes after lens-sparing vitrectomy for macular hole and epiretinal membrane
Dove Medical Press
Purpose: Cataract progression after lens-sparing vitrectomy might differ according to original posterior segment diseases. Our objective was to analyze the refractive values after lens-sparing vitrectomy for macular hole (MH) and epiretinal membrane (ERM).


Vitrectomy yields more macular hole closures than Jetrea
Healio
BOSTON — Visual outcomes were similar in eyes with bilateral macular holes that underwent a vitrectomy or intravitreal ocriplasmin injection, but primary macular hole closure rates were higher in eyes that underwent a vitrectomy, according to a poster ...


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 ...


Retinal Surgery Devices Market To Reach Worth US$ 2757.1 Mn By 2025 – Credence Research
Mobile Computing Today
Diabetic retinopathy, retinal detachment and macular hole, epiretinal membrane procedure, and ocular injury and infections are the major disease sites where retinal surgery devices find application. Among these, diabetic retinopathy holds the largest ...

and more »

Healio

Vascular Density of Retinal Capillary Plexuses in Different Subtypes of Macular Hole
Healio
Although OCT-based diagnostic criteria for full-thickness macular hole (FTMH) and for non-FTMH have been fully described in literature, significant controversy still exists regarding their pathogenesis, management, and prognosis. Indeed, much ...


'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 ...


macular degeneration
Hackaday
Doctors put them down your cake hole to look for ulcers and polyps, and mechanics probe pistons with them to check for buildup. [agulesin] used one to make a reading aid for his mom. Mom suffers from macular degeneration, and can't read print smaller ...

and more »

Vitrectomy Devices Market Is Set to Boom by 2023
Digital Journal
Applications covered in the study include diabetic retinopathy, retinal detachment, epiretinal membrane, and macular hole, and others (eye infections and eye injuries). Geographical breakdown and deep analysis of each of the aforesaid segments is ...


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 ...


TODAY's Area Briefs
Washington Times Herald
Healthy Senior Day will be held at the Community Building in Eastside Park Friday, Sept. 29, from 9 a.m. to 2 p.m. There will be health screenings including finger stick glucose, finger stick cholesterol, vision screenings for glaucoma, macular ...


Research focused on the Global optical coherence tomography market is expected to reach USD 2.4 billion by 2024
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 ...


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 ...


Global Optical Coherence Tomography Market Analysis, Size, Regional Outlook, Competitive Strategies and Forecasts ...
MilTech
On the basis of 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.

and more »

Retinal Surgery Devices Market Is Expected To Reach US$ 2757.1 Mn by 2025: Credence Research
PDF Devices
Diabetic retinopathy, retinal detachment and macular hole, epiretinal membrane procedure, and ocular injury and infections are the major disease sites where retinal surgery devices find application. Among these, diabetic retinopathy holds the largest ...

and more »

Tom's Guide

Galaxy Note 8 User Guide: Features to Enable and Disable
Tom's Guide
In addition to causing eye strain and keeping you up at night, too much blue light from a phone screen can damage your retina and worsen macular degeneration over time. But your Note 8 can cut its blue light output. Here's How: Go to Display and find ...

and more »

Nepafenac reduces risk for macular edema after cataract surgery in select patients
Healio
In total, 4.2% of patients in the cohort with preoperative risk factors, such as contralateral PCME, diabetic retinopathy, retinal vein occlusion, macular hole or epiretinal membrane, developed PCME compared with 2% of patients without preoperative ...


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 ...


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 ...


WLTX.com

Kids Still at Risk During Eclipse Even with Approved Glasses, Doctor Says
WLTX.com
In the very center of her vision, there's a macular hole. So, if she were to look at you out of that eye she wouldn't see your face. She could see everything around you,” said Raykovicz. Doctors say the condition isn't painful, but the retinal damage ...

and more »

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 ...


SCNow

The eclipse and the retina
SCNow
This enables us to clearly see distant objects, such as road signs and constellations; however, when that distant object of interest is the sun, the incoming light is precisely focused and is intense enough to literally burn a hole in the retina ...
How to View the 2017 Solar Eclipse SafelyNASA/JPL Edu News

all 220 news articles »

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.


Baylor College of Medicine News (press release)

Experience the solar eclipse with proper eye protection
Baylor College of Medicine News (press release)
One can even develop something called a macular hole that requires surgery to repair,” Weng said. If you will be viewing the eclipse later this month, Weng says you must protect yourself with special filters. “Shade number 14 welder's glass is a type ...


Persistence is key when promoting surgical innovations
ModernMedicine
... such examples in the history of medical innovations, and one of the classics that Dr. Thompson recounted is that of the tortuous journey of Neil Kelly, MD, and Rob Wendel, MD, retinal specialists who wanted to address the treatment of macular holes ...


B+L next-generation surgical platform features advanced retina capabilities
ModernMedicine
Bausch + Lomb announced the U.S. launch of its vision enhancement system for retina surgery (Stellaris Elite), which integrates advanced retina capabilities into the surgical platform. This next-generation system features multiple advancements as well ...

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