What is a Macular Hole?
macular hole develops within the area of sharp central vision; it is an irregular opening at the centre of the macula which forms over a period of several weeks to months. It develops due to tension from the aging vitreous gel – usually occurring after the age of sixty. Macular holes can also occur after severe blunt trauma to the eye but are rare. Symptoms include reduced clarity of vision and central distortion in the indicated eye.
Diagnoses involves a thorough eye assessment including checking the vision, measurement of intraocular pressure and examination of the retina after drops dilate the pupil. These drops will blur your vision and increase glare for a few hours. You are strongly discouraged from driving home after the assessment.
An Ocular Coherence Tomography (OCT) is performed to measure the size of the macular hole. This is important because the size of the hole affects the surgical prognosis, including closure and potential vision after surgery. it does not take long to acquire the OCT images, and it is non-invasive.
As macular holes are in nerve tissue just over a tenth of a millimetre thick therefore it is not possible to stitch or glue them back together. Instead, microsurgery is performed to remove the abnormal vitreous gel and a very delicate layer of scar tissue on the retinal which releases any tension pulling the hole open. Then, gas is used to fill the eye and support the hole while it repairs and it is naturally resorbed within two weeks. Surgery is performed in the operating theatre under sedation after complete local anaesthesia has been achieved.
Please note: the intraocular manipulation performed during vitrectomy surgery causes physiological changes triggering progressive cataract formation and can result in sub optimal clarity for many months, until cataract surgery is performed. Therefore in some patients, it is advantageous to perform combined cataract surgery with vitrectomy, which offers much faster visual rehabilitation. This will be discussed on an individual basis by your ophthalmologist.
Serious complications such as retinal tears or retinal detachments occur in much less than 5% of cases. Other rarities such as damage from bright light, haemorrhages, severe glaucoma and peripheral vision loss can also occur. There is between a 1-3/1,000 risk of infection.
Fortunately, contemporary macular hole surgery successfully closes the macular hole in approximately 95% of cases, although long-standing and large holes may require further surgery and highly myopic eyes (very short-sighted) can require very specialised techniques to close the hole. In the majority of patients, early treatment results in restoration of virtually normal vision, although some people have a slight reduction in clarity and a small amount of distortion for a number of months. The final visual outcome can take up to 12-18 months to be achieved, after the macular hole closure, but the majority of the improvement occurs within a month or two post surgery.
In general, the sooner the hole is closed the greater the visual improvement. This is not urgent so a delay of 1-2 weeks is acceptable; but surgery is best performed as soon as convenient. Please note that you will not be able to drive for about 2 weeks due to the blurred vision so planning family and work commitments is sensible.