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Macular Hole

Related conditions: Lamellar hole, epiretinal membrane

Background

The macula is the portion of the retina responsible for central vision. In some patients, the vitreous gel, which fills the eye, pulls on the center of the macula, creating a hole. In most patients, this happens spontaneously; however, it can happen after a significant trauma.

FTMH_photo

Full thickness hole in center of retina.

OCT_stages_for_ftmh

Ocular coherence tomography scans showing progressive stages of macular hole. Starting from top with vitreous traction on the macula, causing fluid under the retina (vitreomacular traction), to a small full thickness dehiscence (middle arrow), to a full thickness macular hole (bottom).

If you have a macular hole, your central vision will be diminished. Ocular coherence tomography (OCT) scanning will help you understand what is happening (see above).

Macular holes can often be repaired with pars plana vitrectomy surgery and gas injection. Some doctors require face-down positioning after macular hole repair, while others do not. Ask your doctor about the need for face-down positioning after surgery so you can prepare.

Some macular holes can be treated with an in-office intraocular injection that can close the macular hole in 40–50% of patients without surgery. If you are a candidate, your doctor will discuss this with you.

A lamellar hole is a partial thickness macular hole. This can cause visual problems but does not respond as favorably to surgery as the above conditions.

Most common symptoms

  • Dark spot in center of vision
  • Blurry vision or distortion of central vision

Potential complications

  • Permanent loss of central vision

Treatment

  • Pars plana vitrectomy with membrane peeling and gas injection
  • Intravitreal medication for some macular holes

What to do if you develop these symptoms

  • Schedule an evaluation with a retinal specialist to determine whether you have a macular hole and may be a candidate for pars plana vitrectomy surgery.