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Macular Holes

Allison Menezes, M.D.
Fellowship-trained Retina Specialist

Anita Shane, M.D.
Fellowship-trained Retina Specialist

 

The retina is the light-sensing layer of tissue that lines the back of the eye. A specialized area of the retina, called the macula, is responsible for clear, detailed, central vision. The macula / retina normally lie flat against the back of the eye, like wallpaper lining a wall. A macular hole is an abnormal opening that forms at the center of the macula over a period of several weeks to months. Central vision may become blurred and distorted initially. If the hole progresses, a blind spot develops in the central vision, similar to the picture you would get if camera film had a hole in the center of it. Side vision remains normal, and there is no pain.

 

Most macular holes occur in the elderly. The vitreous gel within the eye pulls on the thin tissue of the macula until it tears. The torn area gradually enlarges to form a round hole. Less common causes of macular holes include trauma and long-term swelling of the macula.

 

Diagnostic tests such as a fluorescein angiogram or optical coherence tomography may be performed in order to determine the extent of the damage to the macula.

 

A macular hole is a full-thickness retinal, circular defect that occurs in the middle of the macula. A "side view" of a macular hole has a very similar appearance to a volcano. The crater of the volcano represents the actual macular hole, whereas the sides of the volcano represent a tiny area of retina that is detached off the back wall of the eye. Although this retinal detachment does not get larger, it does occur in a very critical part of the retina and this results in a significantly more pronounced loss of vision than if the macular hole occurred alone.

 

MACULAR HOLE SURGERY

 

It is almost always preferable to perform macular hole surgery together with a cataract surgery if one is present. Unfortunately, not all retinal surgeons perform cataract surgery. If a cataract surgery is performed at the time of macular hole surgery, then the cataract surgery is performed first. Macular hole surgery is then performed by performing a vitrectomy. He may "peel" some tissues in the vicinity of the macular hole to help increase the chances of the hole closing after the surgery. The eye is then usually filled with a gas of silicone oil bubble. The incisions are at times sutured closed. If a gas bubble is placed in the eye, the patient is asked to keep strict face-down positioning for

a specified period of time. It is felt that the bubble inside the eye physically forces the retina around the macular hole that is detached to reattach. As this tiny area of retina reattaches, the edges of the macular hole (or crater) will approach each other. This causes the hole to become smaller, and in a minority of cases, to disappear. Hence this, combined with the disappearance of the retinal detachment usually improves vision.

 

It is critical that patients maintain their face-down positioning at all times as directed by the retinal surgeon when a gas bubble is used. Failure to do so may result in failure of the operation. Silicone oil is substituted for the gas bubble if patients are not able to comply with face-down positioning. However, silicone oil use requires another operation to remove in order for vision to improve.

 

The macular hole usually closes, and the eye slowly regains part of the lost sight over 2 to 3 months after surgery. The visual outcome may depend on how long the hole was present before surgery. Vision typically does not return all of the way to normal.

 
 
 
 

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Coastal Eye Institute (formerly Manatee Sarasota Eye Clinic) is one of the area’s largest ophthalmology practices featuring a comprehensive team of fellowship-trained ophthalmologists in every subspecialty of eye care.From infancy to the golden years...we provide care for the total health of your eyes. Trust your eye care to our specialists!

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Coastal Eye Institute has fellowship-trained ophthalmologists in every specialty of eye care:

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