Macular Holes: Repair and Surgery

Last updated on June 6th, 2017 at 05:43 pm

It can be extremely scary if vision in one of your eyes suddenly ends up being fuzzy and distorted, as might happen with development of a macular hole.

To understand how macular holes happen, it’s crucial first to understand a little about eye anatomy. The macula, where holes in some cases establish, is an extremely small spot in the center of the back of the eye (retina). Light focuses to a sharp point at the macula, which is the only area of the eye that sees crystal clear, color vision (such as for driving or acknowledging faces).

Macular Hole: What Are They and How to Repair?

The macula likewise has plenty of light-sensitive cells called cones. The entire rest of the retina is made up of photosensitive cells called rods that see black and white shading, shape and movement (such as for night vision and side vision).

Because macular holes frequently relate to aging processes, they are most likely to develop if you are over age 60. Likewise, women have a somewhat higher risk for macular holes than men.

When a macular hole establishes, many people see an unexpected decline in vision in one eye.

Macular holes, tears and cysts are not the same as another age-related eye disease called macular degeneration, which likewise occurs more frequently among those over age 60.


Macular Holes: Repair and Surgery

Macular holes can happen due to:

  • Vitreous shrinking and/or separation
  • Diabetic eye disease
  • High quantities of nearsightedness (myopia)
  • Macular pucker
  • A separated retina
  • Best’s disease (inherited condition triggering macular damage)
  • Eye injury

Macular Hole Caused By Vitreous Shrinkage And/Or Separation

The back of your eye is filled with a rather thick, gel-like material called the vitreous humor (likewise called the vitreous body or the vitreous) that assists your eye keep its shape. The clear vitreous diminishes and becomes more liquid with aging, triggering it to slosh around.

Because the vitreous is connected to the retina with small hairs of cells, it can pull on the retina as it shrinks. Often, this shrinkage can tear off a little piece of the retina, causing a hole. If this missing out on piece of retina remains in the macula, it’s called a macular hole.

Another direct reason for macular holes due to vitreous shrinking is when the hairs remain connected to the retina and break away from the vitreous. These hairs can contract around the macula, triggering the macula to develop a hole from the traction.

In either case, fluid establishes where the vitreous diminishes to fill the spaces. This fluid can permeate into a macular hole, causing blurred and misshaped vision.

Macular Hole Progression

Left neglected, a macular hole can get worse gradually. Macular holes happen in 3 stages:

  1. Foveal detachments — about 50 percent aggravate without treatment.
  2. Partial-thickness holes — about 70 percent worsen without treatment.
  3. Full-thickness holes — most intensify without treatment.

A macular hole sometimes can fix without intervention, but a lot of should be dealt with to avoid permanent vision loss.

Macular Hole Surgery And Repair

A vitrectomy is the most typical treatment for macular holes. In this surgery, a retinal expert gets rid of the vitreous gel to stop it from pulling on the retina. Then the expert inserts a mixture of air and gas into the area once occupied by the vitreous.

This bubble of air and gas puts pressure on the edges of the macular hole, permitting it to recover.

While the bubble is doing its job, you need to lie face down so that the bubble remains in the right place in the eye, in some cases for as long as 2 to 3 weeks! Although it can be very boring and obnoxious to remain still for so long, this approach is definitely needed for you to accomplish the best vision after treatment.

The gas/air bubble gradually goes away gradually, and natural eye fluids take its location while the hole is healing.

Threats of vitreous surgery consist of infection and retinal detachment, both which are treatable. The most common risk, however, is cataract development. Cataracts usually take place rather quickly after a vitrectomy, however they can be gotten rid of when the eye has actually recovered.

If you have had surgery for a macular hole utilizing a gas bubble, you won’t have the ability to travel by air for several months, due to the fact that the gas can broaden with pressure modifications, causing eye damage.

Individuals who have had a macular victory eye have a greater opportunity (about 10 percent) of developing a macular hole in their other eye at a long time in their life. Therefore, you should have regular eye examinations as identified by your optometrist to capture problems early.

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Comments: 1
  1. Mary Frost

    My Mum had macular hole in her left eye about 4 years earlier. She was referred immediately for an operation to “fill” it as she was encouraged it is best not to leave it too long. So please do not ignore it regardless of what your optician may state. She had the op under local anaesthetic (brave lady) which lasted about half an hour. She needed to do something called posturing for 5 days later on (though this varies from professional to professional I think) which is to keep the filler (air bubble) in place. This was challenging but was really effective. Now 4 years on the hole has actually entirely vanished and her sight is very good. I suggest that somebody with this problem speak to someone at the Macular Society. I rang them when my Mum was diagnosed and they were VERY helpful as well as put my Mum in touch with a lady who lived near her who had the same operation so that they might have a chat about it. She discovered this really encouraging. It’s not an easy operation but as I understand the results as typically pretty good.
    Hope this helps somebody.

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