March 10, 2013
Know Your Diseases

What is macular hole?

Macula is an area over the retina responsible for our visual acuity and color vision. Fovea is an area of macula which is responsible for central vision. A macular hole is an either full-thickness or partial thickness break of retinal tissue involving the fovea of the macula.

Which people can develop the macular hole?

Mostly macular hole are idiopathic and occur in old age but it can occur in other age group also because of trauma or secondary to other eye disease like High Myopia, Retinal detachment or Macular Pucker.

Are there different types of macular holes?

Yes, there are three stages to a macular hole:

  1. Foveal detachments (Stage I). Without treatment, about half of Stage I macular holes will progress.
  2. Partial-thickness holes (Stage II). Without treatment, about 70 percent of Stage II macular holes will progress. Partial thickness macular hole is also known as Lamellar hole.
  3. Full-thickness holes (Stage III) with vitreous attachment.
  4. Full-thickness holes (Stage IV) without vitreous attachment.

What factors are responsible for macular hole formation?

Most of the interior of eyes are filled with a jelly like structure called as vitreous which contain fine fibres through which it remain attached to the retina.With aging, the vitreous slowlyliquefy and shrinks and pulls away from the retinal surface.In old age due to liquefaction and shrinkage of vitreous occurs which creates a tangential traction to be exerted over the fovea. Initially this traction tends to lift up the fovea causing loss of foveal contour and shallow detachment of fovea from its bed i.e. pigment epithelium layer. Later on persistent traction causes break in the continuity of the retinal layers at fovea & development of macular hole.

What symptomswill I develop?

In early stages of macular hole development, symptoms may not be obviousbut later oncentral vision is affected. During early phase of vitreo-macular traction there is blurring in central vision along withdistortion of images. Later on after formation of macular hole there is more decrease in visual acuity with blurring of central vision.Peripheral vision remains sharp till later stages.

How can it be diagnosed?

Macular hole is mostly diagnosed by clinical examination of retina by slit lamp biomicroscopy & indirect ophthalmoscopy. In some cases OCT is done to confirm the diagnosis. Other investigation Fundus Fluorescein Angiography can be done but they are not confirmatory.

Is Macular Hole treatable?

Yes, macular hole is treated by surgery. Although few macular holes close spontaneously, mostly macular holes need surgery to improve the vision. Aim of surgery is to remove the sources of traction from the retina to close the hole. In the surgical procedure the vitreous gel is removed along with internal limiting membrane layer of retina to relieve the traction. A gas is filled in the vitreous cavity which acts as an internal tamponade over the holewhich helps in closure of hole. Later on Gas absorbs by 6 to 8 weeks and replaced by natural fluids.

Can I see immediately after surgery?

Gas bubble present in vitreous cavity reflects the light so visibility is poor till gas is present in the cavity. Later on vision recovers slowly as the gas absorbs. Maximumvisionusually restore by approximately2-3 months.

What post-operative care will be needed?

After surgery face down position is crucial to close the hole. Face down position must be maintained minimum 10-12 hours daily for 2 weeks. Travelling in air is restricted till gas is present in vitreous cavity, because change in air pressure may cause expansion of gas which may lead to dangerous rise in intraocular pressure.

What if someone cannot remain in a face-down position after the surgery?

If someone cannot remain in a face-down position for the required period after surgery, vision recovery may not be successful. People who are unable to remain in a face-down position for this length of time may not be good candidates for macular hole surgery.

What are the complications of surgery?

The most common complication of surgery is progression of cataract development. Sometimes cataract needs extraction. Other complications are Retinal Detachment and infection. Retinal detachment secondary to macular hole is very difficult to treat and visual recovery is poor.

What are the possibilities of getting vision after surgery?

Possibility of getting vision after surgery varies from patients to patients. The main factors determining the success of surgery is duration and size of macular hole.Smaller holes have better chances of closure& macular holes of less than six months have greaterpossibility of visual recovery.

Can I develop macular hole in another eye?

If a macular hole exists in one eye, there is a 6-7 percent chances that a macular hole will develop in your other eye over your lifetime.