MACULAR HOLE

You should read this information sheet in conjunction with the vitrectomy information sheet.

A macular hole occurs in the macular region of the retina. The retina is the seeing part of the eye. A macular hole tends to develop around the age of 65 and is 4 times more common in females. It is thought to be due to a transparent membrane on the surface of the retina, which contracts and causes a stretching progressive enlargement of a hole in the most sensitive part of the retina. Eventually fluid can collect beneath the retina causing further deterioration of vision.


Natural course

There are 4 stages of macular hole -( 1 to 4).

80 to 90% progress from stage 2 onwards.

60% of eyes with macular hole eventually only see the top or the second line ( the largest letters) on the test chart.

Less than 10% retain driving vision in the eye with macula hole.

A macular hole can develop in the second eye.

The risk to the second eye is 7%, by 6 years later.

It is extremely rare for the condition to recover without treatment( 3%).


Treatment

The aim of treatment is to peel away the membrane and seal the hole. The procedure usually requires a gas bubble to be placed inside the eye to seal the hole. Afterwards strict posturing is essential for the success of the operation.


Results

The best results are achieved in patients who have not had symptoms for long that is less than 6 months do better than less than a year. Similarly the better the vision the better the results.

Furthermore the more advanced stages do worse.

For example: For stage 2 there is 90% success for closure of the hole. For stage 3 to 4, there is 30 to 70% successful closure.

For a large group of patients receiving treatment, I would expect half the patients to report an improvement in vision. Half would report no change and 5% would be worse.


Late problems

Macular holes sometimes reopen, then further surgery can be considered.

Within 2 years of surgery it is very likely that a cataract would have developed, requiring surgery.

Rarely retinal detachment occurs.