Macular Hole

Macular Hole

What is Macular Hole ?
The macula is a small area in the centre of the retina where light is sharply focused to produce the detailed colour vision needed for tasks such as reading and driving. When a full-thickness defect develops in the macula, the condition is referred to as macular hole.

What are the symptoms of Macular Hole?
The most common symptom of macular hole is a gradual decline in the central vision of the affected eye. This can occur as:
• Blurring
• Distortion (straight lines appearing wavy)
• A dark spot in the central vision
The degree to which vision is affected will depend on the size and location of the macular hole, as well as the stage of its development.

What is the cause of Macular Hole?
The majority of cases develop spontaneously without an obvious cause. Old age is the commonest cause, injury to the eye can also cause macular hole.

Are Macular Holes common?
Macular hole is a relatively common cause of central visual loss, with a prevalence of approximately 3:1000; onset is most common in females aged 60–70. The risk of fellow eye involvement at 5 years is around 10%.

How can we diagnose Macular Hole?
Optical coherence tomography (OCT) is the current gold standard in the diagnosis, staging, and management of macular holes. This quick, non-invasive imaging technique allows for evaluation of the macula in high resolution using reflected light, and helps your doctor differentiate a hole from other eye conditions with similar symptoms.

How can Macular Hole be treated ?
The only consistently successful way to treat a macular hole is an operation. Eye drops or glasses are ineffective.

What is the success rate of macular hole surgery ?
The success rate of macular hole surgery depends on many factors, and you should discuss these with your eye doctor. Overall, there is about a 90% chance of closing the macular hole. Nevertheless, there is a small chance that your vision may not improve after surgery, even if the hole is closed.

The surgery for macular hole involves Vitrectomy procedure using the latest Micro Incision technique (MIVS) using very fine instruments. In most of the cases the surgery is sutureless. A very thin layer called ILM is often peeled from the macula releasing the traction. The eye is then filled with a temporary gas bubble, which presses the hole flat onto the back of the eye to help it seal. The bubble of gas will block the vision while it is present, but it slowly disappears over a period of about 4 to 8 weeks, depending on the type of gas used.

What are the complications of macular hole surgery ?
Surgery for macular hole repairs is generally very safe. However, there are risks and consequences.

If you have not had cataract surgery, a macular hole operation will accelerate the development of a cataract. It is therefore likely that you will need cataract surgery in the future. The time frame for this can range from weeks to years.

There are some possible complications following macular hole surgery such as infection, inflammation, bleeding, retinal detachment, glaucoma and distortion or alteration of vision, but serious side effects are uncommon. There is a very small risk (less than one in 1,000) that you could lose the sight in the operated eye completely as a consequence of the operation.

What is the anaesthesia used for this surgery ?
Most operations for macular holes are performed under a local anaesthetic, which means you will be awake throughout your operation. We will inject local anaesthetic into the area around your eye to numb your eye and prevent you from feeling any pain during the operation. You will not be able to see details of what is happening, but you might be aware of the bright lights or movement in the operating theatre. During the operation, we will ask you to lie as flat as possible and keep your head still.

At the end of the operation, we usually put a pad and shield over your eye to protect it. These will be removed the morning after your surgery.

Please note that you must not fly while you have the gas in your eye for between 4 to 8 weeks depending on which gas is used.

What are the factors which affect the results of the surgery?

Result of the surgery largely depend on size and width of macular hole at the time of presentation. Early surgery is associated with better visual outcomes.

Synergy Eye Care is well equipped and its doctors are well experienced in treating this disease using required procedures and /or surgeries with good results.

Disclaimer: Information published here is for educational purposes only and is not intended to replace medical advice. If you suspect that you have a health problem, please consult your doctor immediately