A macular hole is a tear in the macula, a central area of the retina responsible for the eye's fine focus abilities. It is caused primarily by shrinkage of the gel-like vitreous that helps the eye keep its round shape. If left untreated, a macular hole can lead to serious long-term vision loss. Surgical repair is the most common treatment option.
Understanding Macular Holes
The vitreous fills roughly 80 percent of the eye's interior, and contains millions of tiny fibers that attach it firmly to the retina. In children, the thickness of the vitreous is similar to that of egg whites, but over time it gradually thins until it reaches a much more fluid consistency. When this occurs, the vitreous may begin to shrink away from the surface of the retina. As it does so, it exerts force on the fibers holding it to the retina. When that force becomes too great, the fibers disrupt the retinal surface, leading to the symptoms of a macular hole.
Surgery and Recovery
According to the National Eye Institute (NEI), the standard surgery to repair a macular hole is a procedure called a vitrectomy. If you require this treatment, the procedure will be performed under local anesthetic on either an inpatient or outpatient basis. During your vitrectomy, your surgeon will remove the vitreous from inside your eye and replace it temporarily with a bubble of gas and air. This bubble holds the edges of the macular hole in place, and its pressure encourages the macula to reattach to your retina. Eventually, the bubble dissipates and is gradually replaced by fluids secreted from your eye.
The most difficult part of a vitrectomy actually takes place after the surgery. For a time period that may last from two days to three weeks, you will need to remain in a face-down position in order to allow proper macular healing to take place. Without this step, the chances of successful repair of your macula drop significantly. If you have difficulty maintaining the necessary posture, your doctor may provide you with a device to decrease your discomfort. Prior to surgery, you may also ask your doctor about vitrectomy options that will diminish the normal recovery time.
Your recovery from a vitrectomy may take as long as 3 months. Potential side effects of the procedure include a rapid rate of cataract development, retinal detachment and infection. If they occur, your cataracts may become severe.
Potential Outcomes
The chances for a positive vitrectomy result depend largely on the amount of time your macular hole developed prior to surgery. If your condition existed for less than 6 months before your operation, a successful outcome is much more likely.
Additional Surgical Methods
As of September 2009, the NEI lists vitrectomy as the only well-developed surgical option for treating macular holes. While research is under way to refine other treatment choices, no other technique is currently ready for use. Consult your surgeon for any questions you may have about the details of vitrectomy.
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