Macula – the macula is a small area in the center of the retina which is responsible for central and fine detail vision.
A macular hole is a break or a gap in the macula.
Symptoms of Macular Hole
Blurring of vision
Metamorphopsia or distortion of the central vision
Scotoma or seeing a black spot or patch in the central vision
Causes of Macular Hole
They are commonly affecting people who are 60 years old and above. They also seem to be more common in women than men. Most cases develop spontaneously without a probable cause, but some conditions may increase the risk of developing a macular hole.
Conditions associated with macular hole:
Idiopathic. This is the most common cause. It can occur without any known cause especially in old age
Vitreomacular traction – the vitreous, which is the gel-like material inside the eye, shrinks and detaches from the retina. If some of the gel remains attached, the pulling away may cause a macular hole.
Retinal detachment – this is when the retina pulls away from the underlying tissue. A detachment or a history of detachment or tear increases the risk in developing a macular hole.
Macular pucker – this is the formation of scar tissue over the macula that can cause wrinkling of the retina.
Injury or trauma to the eye
High degree of nearsightedness or myopia
Diabetic eye disease
Diagnosis Of Macular Hole
Optical Coherence Tomography (OCT)
OCT is a non-invasive imaging technique that uses light-waves to create high-resolution images of the retina. The distinctive layers of the retina can be viewed which helps in differentiating different retinal conditions. Diagnosis, staging and severity of macular holes can be done with the use of OCT.
Treatment Of Macular Hole
Ocriplasmin intravitreal injection (Jetrea®)
Ocriplasmin helps to loosen or separate the vitreous gel from the back of the eye. The removal of traction allows the macular hole to close. The procedure is done in an outpatient setting that takes about 5-10 minutes; the injection of the medication itself only takes a few seconds. The procedure is done under local anesthesia. Ocriplasmin is given only on the earlier stages of macular hole development.
Vitrectomy is the surgical removal of the vitreous gel of the eye to remove the pulling effect on the retina. It is the most effective treatment in repairing a macular hole. This is a form of keyhole surgery which is performed under a microscope. Three small incisions are made on the sclera (white part of the eye) where very fine instruments are inserted. In this procedure, the vitreous gel will be removed first. It will then be replaced with a gas bubble that serves as temporary bandage to flatten and hold the edges of the macular hole in place while it heals. This gas bubble gradually dissolves on its own.
A macular hole surgery usually takes 1 to 1.5 hrs. It is performed under local anesthesia but patients can also opt for general anesthesia. Patients may be discharged on the same day or the following day as required.
Some of the lost vision might be regained as the macular hole closes. Vision regained generally depends on the stage and duration of the condition prior to the treatment.