A macular hole is a break or opening in the retina involving the macula. It is usually round in shape which is different from most peripheral retina breaks.
What Causes a Macular Hole?
In most cases it is idiopathic. It is more common as we age. Myopic eye, ocular inflammation, and ocular trauma can contribute to the development of a macular hole.
It is felt that macular holes develop from traction on the macula from the posterior hyaloids face. Also, traction that is tangential on the surface of the macula by vitreous, retinal pigment epithelial, and retinal glial cells contributes to the development of macular holes.
Incidence of Macular Holes
People are usually age 60 or older with more women than men having a macular hole.
Symptoms of Macular Holes
Many patients complain of an area of blurred or missing vision in the center of their vision. Distortion (metamorphopsia), blurred vision, and vision loss are common complaints that people notice with a macular hole.
Diagnosis of Macular Holes
A macular hole can be diagnosed with a complete dilated eye exam. In some cases, an OCT can help in the diagnosis.
OCT is useful in the diagnosis and management of macular holes. It can help assist in the diagnosis of the early stages of macular holes and with the staging of macular holes. Intraretinal and subretinal fluid may be present and found with an OCT.
Fluorescein angiography is not used often for the diagnosis of a macular hole since the development of OCT.
Stages of Macular Holes
Stage1 or impending macular hole is the loss of the normal foveal (fovea is the center of the macula) depression. There is loss of the foveal contour with a yellowish coloration.
Stage 2 is a full thickness break or hole less than 400 microns in size. In most cases, the posterior hyaloid is still attached to the macula.
Stage 3 is the further advancement of the macular hole to greater than 400 microns. The posterior hyaloid is detached from the foveal area of the macula.
Stage 4 is stage 3 with a complete posterior detachment of the hyaloid face and a Weiss ring.
Treatment of Macular Holes
There is no medical treatment for macular holes. In the early part of stage 1, the patient can be followed and in many cases it will reverse with time.
A pars plana vitrectomy is the treatment for a macular hole that is progressing and/or has significant visual loss. A gas bubble is almost always used to press against the macula area. The patient will have to maintain a head down position for a few days to help with the closure of the hole.
Results of Surgical Treatment of Macular Holes
Many patients have a significant improvement in their vision. The severity and the length of time that the macular hole was present contribute greatly to the visual outcome. It may take a few months before the final visual outcome is known.