A macular hole occurs when there is a tear in the macula – the central part of the retina that is responsible for processing detailed images. The macula is the most sensitive part of the retina.
Symptoms of a macular hole include a gradual worsening of central vision or visual distortion (seeing straight lines as wavy).
The best way to detect a macular hole is through an eye examination. Your ophthalmologist will administer eye drops to enlarge the pupils temporarily so that he or she can check the back of your eyes (the retina) for holes.
The eyes are also painlessly scanned with optical coherence tomography (a light used to check the different layers of the retina) to evaluate the macula.
There are no proven preventive measures.
Macular holes usually occur due to stress on the macula. The eye is filled with a clear jelly called the vitreous. When one ages, the vitreous usually becomes more liquefied and may pull on the macula. This may result in a tear of the macula, forming a macular hole. Another cause of macular hole is high myopia, where the elongation of the eyeball puts stress on the macula, causing it to break.
Diagnosis is often made by clinical examination. Investigations like optical coherence tomography and fluorescein angiography may be useful in confirming the diagnosis or excluding underlying causes.
Macular holes may be treated with a vitrectomy, a form of keyhole surgery that uses small probes to enter inside the eye to remove the vitreous. A gas is then injected into the eye to replace the vitreous and prevent it from pulling on the retina.
Following surgery, the patient will need to lie in a face-down position for one to two weeks to allow the gas bubble to press against the macula and seal the hole. The eye will refill naturally with fluid. The success of improving the vision varies from person to person and ranges from 60% to 80%.
Eye drops will be dispensed after surgery, and should be used as prescribed. Good eye hygiene and avoiding injury to the operated eye are important to reduce infection and problems after surgery.
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