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Other Names:
Macular cyst,
retinal hole, retinal tear, and retinal perforation.
A macular hole
is a small break in the macula, located in the center of the eye's
light-sensitive tissue called the retina. The macula provides the sharp, central
vision we need for reading, driving, and seeing fine detail.
A macular hole
can cause blurred and distorted central vision. Macular holes are related to
aging and usually occur in people over age 60.
Is a macular hole the same as
age-related macular degeneration?
No. Macular
holes and age-related macular degeneration are two separate and distinct
conditions, although the symptoms for each are similar. Both conditions are
common in people 60 and over. An eye care professional will know the difference.
Most of the
eye's interior is filled with vitreous, a gel-like substance that fills about
2/3 of the eye and helps it maintain a round shape. The vitreous contains
millions of fine fibers that are attached to the surface of the retina. As we
age, the vitreous slowly shrinks and pulls away from the retinal surface.
Natural fluids fill the area where the vitreous has contracted. This is normal.
In most cases, there are no adverse effects. Some patients may experience a
small increase in floaters, which are little "cobwebs" or specks that seem to
float about in your field of vision.
However, if
the vitreous is firmly attached to the retina when it pulls away, it can tear
the retina and create a macular hole. Also, once the vitreous has pulled away
from the surface of the retina, some of the fibers can remain on the retinal
surface and can contract. This increases tension on the retina and can lead to a
macular hole. In either case, the fluid that has replaced the shrunken vitreous
can then seep through the hole onto the macula, blurring and distorting central
vision.
Macular holes
can also occur from eye disorders, such as high myopia (nearsightedness),
macular pucker, and retinal detachment; eye disease, such diabetic retinopathy
and Best's disease; and injury to the eye.
Macular holes
often begin gradually. In the early stage of a macular hole, people may notice a
slight distortion or blurriness in their straight-ahead vision. Straight lines
or objects can begin to look bent or wavy. Reading and performing other routine
tasks with the affected eye become difficult.
Yes, they fall into the following
categories:
·
Classic macular holes: also
called idiopathic or degenerative macular holes, these are much more common than
other types. These are of the type that will likely benefit most from surgery,
if certain criteria are met.
·
Traumatic macular holes: these
usually occur with direct impact occurring on the eye or head. Some of the
traumatic cases spontaneously heal ("close" or "seal"). Surgery is less
successful in this group but can be performed if the doctor thinks the retina
and underlying
retinal pigment epithelium are functioning
well.
·
Macular holes caused by long-standing macular edema (swelling), which can be
caused by diabetic retinopathy, branch vein occlusion, pars planitis, or other
inflammatory eye disease. Patients with holes of this type should not be treated
with surgery.
Although some
macular holes can seal themselves and require no treatment, surgery is necessary
in many cases to help improve vision. In this surgical procedure--called a
vitrectomy--the vitreous gel is removed to prevent it from pulling on the retina
and replaced with a bubble containing a mixture of air and gas. The bubble acts
as an internal, temporary bandage that holds the edge of the macular hole in
place as it heals. Surgery is performed under local anesthesia and often on an
out-patient basis.
Following
surgery, patients must remain in a face-down position, normally for a day or two
but sometimes for as long as two-to-three weeks. This position allows the bubble
to press against the macula and be gradually reabsorbed by the eye, sealing the
hole. As the bubble is reabsorbed, the vitreous cavity refills with natural eye
fluids.
Maintaining a
face-down position is crucial to the success of the surgery. Because this
position can be difficult for many people, it is important to discuss this with
your doctor before surgery.
The most
common risk following macular hole surgery is an increase in the rate of
cataract development. In most patients, a cataract can progress rapidly, and
often becomes severe enough to require removal. Other less common complications
include infection and retinal detachment either during surgery or afterward,
both of which can be immediately treated.
For a few
months after surgery, patients are not permitted to travel by air. Changes in
air pressure may cause the bubble in the eye to expand, increasing pressure
inside the eye.
Vision
improvement varies from patient to patient. People that have had a macular hole
for less than six months have a better chance of recovering vision than those
who have had one for a longer period. Discuss vision recovery with your doctor
before your surgery. Vision recovery can continue for as long as three months
after surgery.
If you cannot
remain in a face-down position for the required period after surgery, vision
recovery may not be successful. People who are unable to remain in a face-down
position for this length of time may not be good candidates for a vitrectomy.
However, there are a number of devices that can make the "face-down" recovery
period easier on you. There are also some approaches that can decrease the
amount of "face-down" time. Discuss these with your doctor.
If a macular
hole exists in one eye, there is a 10-15 percent chance that a macular hole will
develop in your other eye over your lifetime. Your doctor can discuss this with
you.
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EYE REPUBLIC
Ophthalmology Atlas
CLINIC INFORMATION
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EYE REPUBLIC Ophthalmology Clinic
Manila
3/F Don Santiago Building Units 309-310
1344 Taft Avenue, Ermita
Manila, 1000 Philippines
Direct and Fax: (632) 536-2398
Trunk Line: (632) 523-8271 to 79 local 30
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EYE REPUBLIC
Ophthalmology Clinic
Asian Hospital
and Medical Center
5/F Medical Office
Building (MOB) Suite 509
2205 Civic Drive,
Filinvest, Alabang
Muntinlupa City,
1781 Philippines
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Medical City
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MERALCO Compound, Ortigas Avenue
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EYE REPUBLIC
Ophthalmology Clinic
St. Luke's
Medical Center
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Cathedral Heights Building Complex (CHBC)
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MACULAR HOLE information compiled by
Dr.
Edmin Michael G. Santos and initially uploaded on May 1, 2005.
Last updated on
September 14, 2007. |
