Macula holes

What is a macula hole?

A macular hole

A macular hole

The retina is a thin layer of light sensitive cells lie at the back of the eye. Generally the retinal is less than 1/20th of a millimetre thick. It is attached to the jelly in the eye – called the vitreous. As we get older the vitreous detaches from the back of the eye. As it detaches the gel falls forward and pulls on the retina. The gel pulls on the center of the retina called the macula and a hole can form.

What are the symptoms of a macular hole?

The macula provides us with focused vision for distance and reading vision. A macula hole will cause distortion and blurring of vision, straight objects can appear crooked or have a ‘waist’. Colour vision is also affected.

How is a macula hole treated?

A macula hole is treated with an operation called a phaco / vitrectomy. The eye lens is removed and replaced with a plastic lens. The gel is then removed from the eye, any residual membrane peeled and the eye is filled with a long acting gas. The gas stays in the eye for around 50 days. Over the first month or so the vision is reduced by the gas.

This operation is generally successful, however in 10-15% of patients, the hole does not close and another operation is needed. When the hole closes most patients see an improvement of vision that takes 3-6 months to happen. About 20% do not have an improvement in vision even if the hole closes.

This is a OCT scan through a macular hole there is complete separation of the retinal edges and fluid under the retina.

This is a OCT scan through a macular hole there is complete separation of the retinal edges and fluid under the retina.

What happens during surgery?

The surgery can take place in the day case theatre. First the eye’s pupil will be dilated with drops, this takes about 20 minutes. Then a local anaesthetic will be infused around the eye. The operation usually takes 30-40 minutes.

Are there any risks with surgery?

Some patients develop a retinal detachment, which can reduce vision dramatically. If detected early these can also be operated on and vision restored. Other risks include infection of the eye, and reoccurrence of the macular hole.

What happens after treatment?

Immediately after the treatment, the eye will be padded and kept comfortable. A patient may be asked to take Diamox tablets to control post operative pressure rises. The eye should be examined the following day and post operative drops are usually prescribed. A patient will not be able to see well from the eye for at least one month. A patient should not fly or have a general anaesthetic as either could cause blindness.

Long term a patient may find their glasses’ prescription changing and often a cataract develops. This can be removed with cataract surgery.

Is a macular hole the same as macular degeneration?

No, macular holes and macular degeneration are two separate and distinct conditions. Macular degeneration is a condition affecting the tissues lying under the retina, while a macular hole involves damage from within the eye.

What are the chances of a macular hole in the other eye?

The risk of developing a macular hole in the other eye is relatively small, around 5% per year.

Can I prevent a hole forming in the other eye?

There is no way of preventing a macular hole in the second eye, however a patient should notice the symptoms more rapidly and can be operated on immediately.

How long can macular hole surgery wait?

The best results happen when the macular hole has been present for less than 6 months. If it has been present for more than a year, then the chance of recovery is small.