The macula is the central part of the retina, which is a thin membrane that lines the back wall of the eye. The macula is responsible for your fine distance vision, your color vision, and your reading vision. The very central part of the macula is called the fovea, which is the location of your clearest and best vision. This is the region that is affected by macular holes. In between the lens in the eye and the retina lies a jelly-like substance called the vitreous gel, which has an important role in the development of macular holes.
Possible signs of a macular hole include a gradual onset of loss or distortion of the central field of vision.
Causes of Macular Holes
Macular holes may be caused by injury or inflammatory swelling of the retina, but most commonly occur as an age-related event without any predisposing conditions. The vitreous gel is tightly attached to the retina when you are born but gradually separates from the retina as you become older. Macular holes are caused by pulling or traction as the vitreous gel separates from the retina in the macula and around the fovea.
Treatment of Macular Holes
Surgery is the treatment of choice for full-thickness (meaning a hole through all layers of the retina) macular holes. The surgery involves removal of the vitreous gel sac through three microscopic incisions through the sclera. A small layer of scar tissue or membrane may also be removed from the surface of the retina. A gas bubble is then placed in the eye.
The surgery takes less than an hour with minimal discomfort. The patient is then asked to maintain a face-down position for three to seven days, or longer, depending upon the discretion of the retinal surgeon. The gas bubble goes away by itself in two to eight weeks, depending on the type of gas bubble used.
Read our interview with Antonio Capone, Jr., MD and learn about his pioneering work in reducing the time required for face-down positioning after macular hole surgery.
The most common side effect from macular hole surgery is the development of a cataract in patients who have not already undergone cataract surgery. The chance of developing a cataract is over 80 percent and is related to the surgery and gas bubble. In order to achieve the best possible vision, cataract surgery is typically performed after the gas bubble has dissipated.