A macular hole is a defect within the very center of the macula, the portion of the retina that is responsible for our fine detail oriented central vision. Reading and threading a needle are examples of “macular” vision. Macular holes almost always occur during the natural aging process. The vitreous gel within the eye undergoes changes that cause a tractional “pulling” around the center of the macula. The combination of these forces around the macula results in the formation of a hole. Other less common causes of macular holes may be related to trauma, a high degree of nearsightedness (myopia), and chronic swelling of the macula. Women are more likely to develop a macular hole.
At first, a macular hole may cause only a small blur or distorted area in the center of vision. As the hole grows and expands over several weeks to months, central vision progressively worsens. Peripheral vision is not affected and there is no risk of blindness. The duration and size of your macular hole will determine the level of visual recovery following repair. For this reason, prompt surgical intervention following diagnosis is recommended.
Surgery is extremely effective in the treatment of macular holes. A vitrectomy is performed on an outpatient basis. Removal of the vitreous gel and dissection and peeling of the “tractional” macular membrane is completed under surgical microscopic control. A gas bubble is injected into the eye to help promote closure of the macular hole. Face down head positioning for several days following surgery will enable the bubble within the eye to remain in constant contact with the macula. The gas bubble acts as an internal bandage and is crucial to maximize the rate of surgical success. You may not fly in an airplane or travel to high altitudes with a gas bubble in your eye. The change in air pressure may result in a dangerous increase in the pressure within your eye. Dr. Cohen and Dr. Kanter will notify you when it is safe to travel following surgery.