Macular Hole

A macular hole is thought to be caused by traction of the vitreous, the gel inside the back of the eye on the retina. The pulling of the vitreous on the center of the retina results in the formation of an opening in the center of the macula (another name for the very center of the retina). The resulting visual loss is perceived as a blind spot and/or distortion in the center of vision.

Vitrectomy with macular hole repair is the only definitive treatment for repairing the macular hole. In this procedure, the vitreous is removed through vitrectomy surgery, followed by peeling the inner-most layer of the retina, the inner limiting membrane. In this manner, the traction on the hole is relieved. At the end of the procedure the fluid in the back of the eye is replaced with a gas bubble which gently pushes the edges of the hole together allowing it to seal. The bubble will last two to eight weeks and will spontaneously dissipate. Importantly, patients are asked to remain face down for a period of time following surgery to place the gas bubble in the most effective position for hole closure. There is strictly no air travel while the gas bubble is in the eye as the bubble will expand with ascent to high altitude and cause serious complications.

Vitrectomy for macular holes is usually successful with over 90% of holes closed with a single surgery. Visual results of successful surgery are variable with most patients experiencing significant improvement in visual acuity and quality of vision after surgery.

For more information about this condition:

1) Macular Hole information from ASRS Retinal Health Series

2) Informational video from the American Academy of Ophthalmology: