A macular hole is a physical hole in the center vision called the macula. When small, a macular hole results in a modest reduction in vision. Over time it tends to enlarge and can result in a profound loss of central vision. In general, any full thickness macular hole would benefit from intervention.
The very central vision is one of the thinnest points of the retina. The hole in the central vision is thought to occur due to the jelly in the eye pulling on the retina and leading to this thin area separating into a hole.
Injections in the eye of specialized medications have shown promise in treating small macular holes. However, there is a cost for this medication. Often, surgery will still need to be done.
Surgery is the only method of treating larger macular holes.
Vitrectomy and Membrane Peeling
Vitrectomy is the technique for surgical treatment of macular holes. It involves making three small ports in the eye. These ports are so small that they usually do not require any stitches to close as they self-seal. One port is for an infusion fluid to keep the eye pressure, while the other ports are used to introduce a light and a cutter. The light allows the surgeon to see into the inside of the eye through a microscope. The cutter is used to remove the vitreous jelly which is attached to the retina. By fully removing the jelly, the traction pulling on the macular hole is removed. Once the jelly is removed, small forceps and high microscope magnification are used to peel off a retinal film that helps decrease the traction on the macular hole. The eye is then filled with gas to help push the hole closed.
After surgery, patients must keep their heads down for four days. Patients can take a 5 minute break every hour.