Macular Holecauses, symptoms and treatments

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Last updated 9/29/2019
Macular Hole, Retina Conditions, Assil Eye Institute

What's a Macular Hole?

The macula is an area of highly specialized cells located in the central portion of the retina, which is the delicate inner lining of the back of the eye.

 

The macula is responsible for distinguishing fine details, perceive facial features, read printed material or focus on distant objects in order to drive, for example.

 

A macular hole is a small full thickness break in the lining at the very center of the macula. Macular holes are not uncommon. They occur more frequently after 55 years of age and women are somewhat more affected than men.

Macular holes causes

 

The cause of macular holes is not well understood, but the risk of developing a macular hole is increased for:

  • Nearsighted patients 
  • Persons who have had blunt eye trauma
  • Diabetics
  • People with a condition where the gel inside their eye pulls away from the retina (known as vitreomacular traction).
  • Folks who already have a macular hole in one eye as they have a 15 percent chance of developing a macular hole in their other eye

 

Macular hole symptoms 

Actually, it´s not so easy to know whether you have a macular hole because they are painless. The most common symptom of a macular hole is a gradual decline in central vision. This can take the form of blurred vision, distorted vision (where straight lines will appear wavy) or a growing dark spot in the central visual field.

 

The diagnosis of a macular hole requires a dilated eye exam with close inspection of the retina plus an imaging test called an OCT (ocular coherence tomography) that uses light waves to take cross-sectional pictures of the retina.

 

Macular hole treatment

Treatment of a macular hole requires a surgery called vitrectomy. In this surgery, tiny instruments are used to remove the gel which fills the inside of the eye. This helps to relieve any traction caused by the gel pulling away from the retinal surface that tugs on the macula.

 

Once the gel is removed, the eye is filled with a special gas bubble which helps to flatten the edges of the macular hole against the eye wall to allow it to grow back together.

 

 

What's unique about macular hole surgery?

The surgery to repair a macular hole is unique because a gas bubble placed in the eye must remain in contact with the macula following surgery in order for the macular hole to remain pressed against the eye wall.

 

In order for this to happen, the patient must lie face down and remain in this position for 5 to 7 days following surgery. This is necessary because gas rises and THE ONLY way to keep the bubble in contact with the macula is to keep the head in a face down position. This is extremely important to the success of the surgery since, without proper positioning, the hole has poor chance of healing.

 

The gas bubble will slowly dissolve on its own over a month or so. While any gas is present in the eye it is CRITICAL to avoid any airplane or altitude travel until cleared to do so by the surgeon. This is because gas expands at altitude and this can cause extreme elevation in eye pressure which can lead to irreversible vision loss.

 

As the macular hole closes, the eye slowly regains part of the lost vision. The extent of vision recovery depends on the size of the hole and how long it was present before surgery. Unfortunately, once a macular hole forms, vision may not return all the way to normal.

 

Treat your macular holes at Assil Eye Institute

The AEI staff includes a highly skilled retina specialist Dr. Svetlana Pilyugina or “Dr. P”, as she is known to her patients.

 

Dr. Pilyugina is an ophthalmologist with fellowship training and board certification in diseases and surgery of the vitreous and retina and over 10 years of experience.

 

Dr. P has and her team have extensive expertise in the medical management and surgical treatment of macular disease.

 

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