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

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Hybrid wide-angle viewing-endoscopic vitrectomy using a 3D visualization system
Dove Medical Press
Purpose: To introduce a hybrid wide-angle viewing-endoscopic vitrectomy, which we have reported, using a 3D visualization system developed recently. Subjects and methods: We report a single center, retrospective, consecutive surgical case series of 113 ...

and more »

Spark Therapeutics Enters into a Licensing and Supply Agreement for Investigational Voretigene Neparvovec Outside ...
GlobeNewswire (press release)
Retinal abnormalities may occur during or following the subretinal injection of LUXTURNA, including macular holes, foveal thinning, loss of foveal function, foveal dehiscence, and retinal hemorrhage. Monitor and manage these retinal abnormalities ...

and more »

Global Retinal Surgery Devices Market, 2017-2025 - Vitrectomy Packs Segment Accounts for the Largest Revenue Share
GlobeNewswire (press release)
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 »

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 ...


LANews By Abhishek Budholiya (press release) (blog)

Retinal Drugs And Biologics Market to Reflect Steady Growth During 2017-2027
LANews By Abhishek Budholiya (press release) (blog)
Retina is a very sensitive and delicate part of human eye which is responsible for receiving and processing light to convert into neural signals and send to the brain for visual activity. The disorders related to retinal health include age-related ...


Retinal Drugs Market Set for Rapid Growth and Trend by 2025
Digital Journal
The central part of the retina is known as macula, which is responsible for central vision. The remaining tissue outside the macula is responsible for peripheral vision. There are many types of retinal diseases. Some of these diseases involve only the ...

and more »

Surgical Technique Shows Promise for Macular Hole Repair: Ophthalmology Times
MedPage Today
The inverted internal limiting membrane flap technique may provide advantages for repairing macular holes compared with the standard surgical approach, according an expert who developed the approach. A new technology -- optical coherence tomography ...


ModernMedicine

Inverted ILM flap technique improves outcomes of macular hole surgery
ModernMedicine
The technique, developed by Dr. Nawrocki and his colleague Zofia Michalewska, MD, PhD, involves covering the macular hole with an inverted remnant of ILM that is left attached to the margins of the macular hole after ILM peeling. The inverted ILM ...


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 ...


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 ...


Autologous retinal transplants are 'true transplants' for macular holes
Healio
NEW ORLEANS — Autologous retinal transplants for macular holes provide “true transplants” and are not just plugs, according to a speaker here. “With the autologous retinal transplant at this stage, we didn't have any major complications. I don't think ...


Vitreous Tamponades Market by Type, End Users, and Region - Global Industry Insights, Trends, Outlook, and ...
Industry Today (press release)
They are majorly used in various retinal disorders such as retinal detachment, diabetic retinopathy, retinitis pigmentosa, retinal degeneration, vascular occlusion, macular hole, epiretinal membrane, macular edema, uveitis, and retinopathy of ...


Retinal Drugs Market Scope and Opportunities Analysis 2017 – 2025
satPRnews (press release)
The central part of the retina is known as macula, which is responsible for central vision. The remaining tissue outside the macula is responsible for peripheral vision. There are many types of retinal diseases. Some of these diseases involve only the ...

and more »

Go for regular eye check-ups
The Straits Times
He says refractive errors are typically detected in eye screening. With the elderly population, other emerging problems are cataracts, diabetic retinopathy (a diabetic eye disease that can result in vision loss) and age-related macular degeneration ...


Market Forecast Report on Retinal Drugs And Biologics Market 2017 – 2027
satPRnews (press release)
Retina is a very sensitive and delicate part of human eye which is responsible for receiving and processing light to convert into neural signals and send to the brain for visual activity. The disorders related to retinal health include age-related ...

and more »

Vascular Density of Retinal Capillary Plexuses in Different Subtypes of Macular Hole
Healio
Dr. Bandello has received personal fees from Allergan, Alimera, Bayer, Novartis, Farmila-thea, Schering Pharma, Sanofi Aventis, Hoffmann-La Roche, Novagali, Genentech, and Pharma outside the submitted work. The remaining authors report no relevant ...


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 ...


Bustle

Is It Safe To Look At A Partial Solar Eclipse? Here's How To Protect Your Eyes
Bustle
If you're unsure why looking at the sun is so dangerous, there's a few reasons. When the sun's rays hit Earth, the first thing to come through is the visible light. However, it is immediately followed by UVB rays. These rays have the potential to burn ...
Another Eclipse Is Coming Thursday. Here's What to Know About the Partial Solar EclipseTIME
Partial Solar Eclipse on February 15, 2018 - Time and DateTime and Date

all 134 news articles »

Positive Newspaper

Retinal Surgery Devices Market Key Factor Responsible For The Industry Growth
Positive Newspaper
Various type of retinal surgery devices such as retinal laser equipment, microscopic illumination equipment, vitrectomy packs, vitrectomy machines, surgical instruments and others are used for the treatment of retinal diseases such as macula pucker ...


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 ...


ModernMedicine

Dye from açai fruit safe, effective for use during chromovitrectomy
ModernMedicine
Patients were included who had a diagnosis of idiopathic macular holes of less than 2 years' duration. The surgical procedure performed by all surgeons included a 23-gauge, four-port combined phacoemulsification/PPV that was guided by staining the ...


Autologous retinal transplantation used to treat macular hole
Healio
Patients who have undergone multiple failed procedures to close macular holes may benefit from a new autologous retinal transplantation technique, according to its developer. Autologous retinal transplantation should be considered for patients who have ...


Technology Networks

FDA Approves Gene Therapy for Inherited Blindness
Technology Networks
The therapy dramatically restored most patients' ability to see, increased their sensitivity to light, and improved their side vision, the researchers reported. In the trials, the gene therapy safety profile was consistent with vitrectomy and ...
FDA approves novel gene therapy to treat patients with a rare form of inherited vision lossFDA.gov

all 127 news articles »

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 ...


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 »

New theory may address idiopathic macular holes
ModernMedicine
New York—The development of idiopathic macular holes can be divided into three distinct phases and one pivotal event involving both tractional and hydration forces, according to Ronald C. Gentile, MD. The exact pathogenesis of macular holes has long ...


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 ...


OCT in operating room helps determine surgical success
Healio
WAILEA, Hawaii — In the evolving vitreoretinal arena, intraoperative and perioperative OCT are indeed useful, according to Rishi P. Singh, MD. Singh gave an update on the utility of the technology to colleagues here at Retina 2018. For one, OCT in the ...


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 ...

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