Macular Hole

Are you having some trouble with the central vision of one of your eyes? Is your vision gradually becoming foggy? You may have a Macular Hole in your retina. Read this article to find out more about the condition, its symptoms, treatment options and more.

What is Macular Hole?

A break or hole in the macula is known as Macular Hole or Macular Cyst. Macula is the oval shaped and highly pigmented yellow spot situated in the central point of the light-sensitive tissue of human eye called retina. Vitrectomy surgery is generally used to cure this eye damage.

Macular Hole Causes

The retina is located at the inside wall of the back of human eyes. The special nerve cells in the retina react to light and help humans to see with their eyes. These nerve cells are located closely together in the retina’s center. The external images are focused at this area for us to see. This small area is known as macula.

The retina and the lens of an eye are separated from each other by a clear gel-like substance called vitreous. The vitreous tends become thicker and starts to shrink back from the retina as an individual become older. If very firmly connected, the shrinking of the vitreous can tear the retina and cause a macular hole.

Sometimes, the withdrawal of the vitreous causes a contraction of the fibers that are located on the surface of the retina. The increased tension in the retina can also result in Macular Hole.

This condition may arise from various eye diseases, including:

  • Macular pucker
  • Retinal detachment
  • Vitelliform macular dystrophy
  • Diabetic retinopathy

Serious injury to the eye can also cause a hole in the macula.

Macular Hole Stages

There are three types or stages of the Macular Hole:

Foveal detachments or Stage I

In around 50% percent of the total cases, the hole keeps developing without proper treatment at the first stage.

Partial-thickness holes or Stage II

The hole continues to grow in this stage as it is not treated properly in almost 70% of the total cases.

Full-thickness holes or Stage III

The deterioration of the vision in the affected eye is determined by the size and location of the hole in the retina. The eye often loses its detailed central vision permanently once the condition reaches the third stage. If a Stage III Macular Hole is left untreated, it can even result in a sight-threatening condition called Detached Retina. This condition requires immediate treatment.

Macular Hole Symptoms

The symptoms of the condition are not very noticeable in the earlier stages. A person is unlikely to have Macular Holes in both eyes. Due to this reason, the symptoms occur only in the one affected eye. During this period, a patient may experience the following symptoms:

  • The central vision of the individual becoming distorted and hazy.
  • A blind spot originating at the center of the vision.
  • The damaged eye slowly losing its ability to see an object located close by or at a distance.

More serious symptoms of this condition include:

  • Inability to see the fine details of an object when looking directly at it, irrespective of its distance.
  • Vision of the affected eye appearing as looking through a wavy glass or thick fog.
  • The blind spot at the center of the vision becoming darker.
  • A sight-threatening condition known as Detached Retina possibly affecting the eye.

Macular Hole Prevention

There is no known way to prevent the condition. However, one should be careful to avoid any serious eye injury or trauma that may lead to the problem.

Macular Hole Diagnosis

One can occasionally cover each eye in turns to see whether or not there is any change in their central vision. This is a useful way of detecting this condition at an early stage.

There are various medical tests that help to correctly diagnose the condition. Ophthalmologists often dilate the pupils to see if there is a hole in the retina of a patient. In the Fluorescein angiography test, a certain dye is used for illuminating different areas of the retina.

The Optical Coherence Tomography (OCT) is another test that can correctly diagnose a hole in the macula. A diagnostic laser camera is used in this test to photograph the retina. The retina thickness can be measured by this test. OCT can also correctly detect swellings and fluid in the retina. This test can detect even the small holes that are impossible to diagnose with angiography or by any other examination.

Macular Hole Repair

Sometimes, the Macular Hole seals itself without any treatment. In most cases, however, surgery is required to repair the hole and improve the vision of the damaged eye. The surgery commonly used for treating this condition is known as Vitrectomy. It uses a gas-air mixture to restore the macula back to its normal condition.

Macular Hole Treatment and Surgery

Small instruments are used in the vitrectomy surgery for removing the vitreous gel pulling on the retina. Pieces of broken tissues are also removed from around the macula as they can prevent the hole in the macula from closing. Laser treatments are not used for repairing Macular Holes as laser can damage the hole even further.

During the vitrectomy surgery, three small holes are made in the wall of the eye: one is used for fluid infusion that maintains the shape of the eye; the second is used for a tiny fiber-optic light and the third hole is used for extracting the vitreous using a vitrector, laser probes or forceps.

In the next stage of the surgery, the surgeon inserts a mixture of gas and air in the vacant area previously filled by the vitreous. The air and gas mixture helps to seal the hole by putting adequate pressure on it. The patient has to remain in a face-down position after the surgery so that the air-gas bubble remains in constant contact with the damaged macula. This condition continues for around a week. The duration of the face-down recovery period is determined by the size of the Macular Hole. The air-gas mixture generally dissolves on its own after sealing the hole. But it is extracted by ophthalmologists in some cases.

Post Surgery Precautions

It is not advisable for sufferers to travel in an air plane before the gas-air bubble is completely dissolved (after repairing the hole). This is because the rapid change in the altitude can increase the eye pressure which is harmful for the eye. Using nitrous gas for local anesthesia is also recommended. However, undergoing local anesthesia without applying nitrous gas is generally safe.

Macular Hole Surgery Recovery Equipment

A number of vitrectomy surgery recovery equipments are available that help patients to maintain the post-surgery head-down posture. These equipments support the head in sitting and lying positions.

Macular Hole Surgery Complications

The two complications that are generally associated with the vitrectomy surgery are:

Cataracts

The surgery increases the risk of cataract in most cases. A cataract grows rapidly and often reaches an advanced stage when it starts to affect the vision. However, it can generally be removed by surgeries.

Retinal detachment

Sometimes, the retina detaches entirely from the eye during the extraction of the vitreous. In these cases, the retina is reattached as soon as possible.

Macular Hole Surgery Success Rate

The vitrectomy surgery has a success rate of above 90%.

Macular Hole Risk Factors

The vitreous gel in the eyes starts drying up with age, thus causing the Macular Hole. People aged over 70 years are more likely to develop a hole in their macula. Women are more prone to this condition as compared to men.

Macular Hole Prognosis

The prognosis depends on the size of the hole and how it has been present in the macula. Generally, the damaged eye recovers its sight to some extent after the surgery. Smaller holes are generally easier to mend as compared to the larger holes. Following the post-surgery instructions given by a surgeon also helps patients to have a better outcome.

Macular Hole requires immediate medical attention. This eye condition is completely curable if treated at the initial stage. However, the disorder can cause serious eye problems including complete vision-loss if left untreated.

Leave a Reply