A macular hole is a small gap or break in the macula that can lead to blurring or distortion of central vision.

Macular Hole Symptoms

In the early stages, the macular hole causes distortion and blurred vision. It makes reading a bit difficult, and straight lines appear wavy. Gradually, it includes gaps in the central vision. Though macular hole can affect either of the eyes, it usually begins in one eye first. Hence, patients do not notice vision loss immediately. If untreated, it may lead to retinal detachment, a sight-threatening condition.

Macular Hole Causes

The eyeball is filled with a clear jelly. It is called ‘vitreous humour’. The jelly shrinks and peels away from the retina as we get older. This process is known as ‘posterior vitreous detachment (PVD). It is harmless in the majority of people. But in some cases, the vitreous humour sticks to the retina, and as it shrinks, it tugs away a bit of the retina, leaving a hole that opens in the macular area of the eye. Also, macular holes can be due to conditions like

  • High myopia
  • Injury
  • Macular pucker
  • Best disease, etc.

Macular Hole Diagnosis

Your eye doctor will put some eye drops to dilate the pupil. Then, the ophthalmologist will perform some special imaging tests like optical coherence tomography (OCT). The OCT scans give detailed cross-sectional views of the retina and macula and help to diagnose a macular hole.

Macular Hole Treatment

Some macular holes do not need any treatment as they can seal themselves. Eye drops and glasses are ineffective in treating macular hole. So, Vitrectomy surgery remains the only effective option. The majority of patients see improvement in their vision after this operation.

Macular Hole Surgery

During macular hole surgery, your surgeon will make a tiny incision in the eye. Vitrectomy surgery is done under the influence of local or general anesthesia. Your doctor will replace the vitreous gel with a bubble of gas. Then, a very delicate layer is peeled off from the retinal surface present around the hole to release the tension that keeps the hole open. The bubble blocks the sight and presses the hole flat to help it seal. The gas bubble is naturally absorbed over a few weeks, depending on the gas used.

Macular Hole After Effects

After the operation, you may be asked to lay face-down for a few days. This is called as ‘posturing’, and it helps the eye heal properly. Other after-effects include temporary poor vision, discomfort, mild pain, etc.

Macular Hole Precautions

Post-surgery, your eye will be padded with a protective shield taped over it. This can be removed the day after the surgery or as per the doctor’s advice. Other precautions include:

  • Do not rub your eye
  • Wear an eyepatch
  • Do not swim as this helps to avoid infection from the water
  • Avoid strenuous exercise
  • Avoid wearing eye make-up
  • Take prescribed medication
  • Do not fly or travel to high altitudes.

Macular Hole Risks

Infection is very rare, but a common side-effect of macular hole surgery is a cataract.  Most people need to undergo cataract surgery after Vitrectomy surgery. Usually, you may need to repeat the surgery, if the hole fails to seal.

Macular Hole Recovery

The gas bubble goes away with time after the surgery. Our natural eye fluids replace the bubble while the hole is healing. The recovery takes several weeks, and with the successful operation, the central vision is improved.

S L Prabhavathi

S L Prabhavathi

MS, FVRS, Vitreo-Retina Surgeon at Neoretina
MBBS (2006-2011): Siddartha Medical College Vijayawada(AP)

MS (2013-2016): PGIMER, Chandigarh

FVRS(2016-2018) LVPEI, Bhubaneshwar

Special Interests: Retinopathy of Prematurity, Diabetic Retinopathy, Retinal Dystrophies, Pediatric Retina.
S L Prabhavathi