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What is a Macular Hole?
A macular hole is a small hole in the center of your retina (macula), the area of the eye responsible for central vision. Macular holes come in different stages. They may present as partial thickness holes for full thickness holes. In some instances, partial thickness holes can self-seal, but most holes require surgery.
What Causes Macular Holes?
The most common cause to macular hole development is aging, specifically in patients over the age of 60. A risk that is slightly higher in females over males. In this the gel-like material that fills the back of the eye (called vitreous humor) shrinks and becomes more liquid with aging, causing it to slosh around.
Because the vitreous is attached to the retina with tiny strands of cells, it can pull on the retina as it shrinks. Sometimes, this shrinkage can tear off a small piece of the retina, causing a hole. If this missing piece of retina is in the macula, it’s called a macular hole.
How are Macular Holes Treated?
Although some macular holes can self-seal without any treatment, most macular holes will require surgery to prevent permanent vision loss and improve one’s vision. A surgical procedure called Vitrectomy is performed, where our surgeon removes the vitreous gel that is pulling the retina and replaces it with a gas bubble. The bubble acts as an internal temporary bandage that holds in place the edge of the macular hole as it heals. As such to maintain the gas tamponade, you must lie face down, sometimes for as long as two weeks! This gas slowly dissipates and is replaced by the body’s own’s fluid.
Vitrectomy surgery is usually performed on an out-patient basis and most patients receive local anesthesia.
What are the Risks to Macular Hole Surgery?
The most common risk factor to Vitrectomy surgery is Cataract development. Cataracts usually occur rather quickly after a vitrectomy, but they can be removed once the eye has healed.
Other potential complications include:
- Eye infection (Endophthalmitis)
- Retinal detachment
- High eye pressure (Glaucoma)
It is important to remember that due to gas bubble placed, one should not travel by air (or by car if there is altitudinal changes) for several months, or until cleared by our surgeon. The gas placed can expand with pressure changes, causing eye damage and vision loss.
What is the Likelihood of Getting a Macular Hole in My Second Eye?
If you have a macular hole in one eye, there is a 10-15% chance that a macular hole will develop in your other eye over your lifetime. Therefore, regular eye examinations are important for early management.
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