Macular hole

The macular hole is a disease that affects the macula. The macular hole can occur without apparent cause and, generally, it happens because the vitreous humor makes traction and pulls the center of the retina, thus causing a hollow on the macula.

When a hole in the macula occurs, it is very difficult for the lesion to close on its own, therefore, in most cases you need to make a vitrectomy

Macular hole

The macular hole is a disease that affects the macula. The macular hole can occur without apparent cause and, generally, it happens because the vitreous humor makes traction and pulls the center of the retina, thus causing a hollow on the macula.

When a hole in the macula occurs, it is very difficult for the lesion to close on its own, therefore, in most cases you need to make a vitrectomy

What is the macular hole?

As we said, the macula is a part of the retina that has a very small size, is located in the center of the retina and is responsible for central vision. Thanks to her, we can perceive the colors and details in the images. It is one of the most important structures of the eyeball and is prone to alterations such as the macular hole or the macular edema.

The macular hole is a hole that forms in the macula when the vitreous humor, a gelatinous substance that occupies the posterior cavity of the eye, pulls and pulls the retina, causing a small hole in the macula. The macular hole is considered a delicate disease, as it can significantly affect our central vision and must be treated in time to prevent possible irreversible damage to the macula. 

The macular hole has different stages ranging from the imminent hole, which is associated with stage 1, to the full hole, which comprises stages 2, 3 and 4. As the macular hole changes stage, visual acuity changes. deteriorates to 1/10 of vision with loss of central vision.

The macular hole is classified according to its origin as follows:

  • Idiopathic or senile: when it is associated with age, since it usually occurs after age 57. 
  • Myopic Macular Hole: is associated with the myopia magna and can cause a retinal detachment
  • Post Traumatic Macular Hole: is associated with injuries, blows or trauma that have occurred directly in the eye.

 

Types of holes in the macula

Depending on the cause and the way in which the macular hole has affected the retina, it can be classified as follows: 

Full macular hole

El full macular hole It is one in which the tear affects the entire thickness of the retina. Usually, these types of holes are considered stage 2, 3 or 4.  

Lamellar macular hole

It occurs when the traction of the epiretinal membrane on the macula it is centrifuged and causes a separation of the layers of the retina in the fovea. This separation is called lamellar macular hole, and with the passage of time it can become a complete macular hole.  

macular hole

Causes that cause it

The macular hole is a retinal condition that can be caused by adverse causes, being the most common: 

  • The posterior cavity of the eye is occupied by vitreous humor, a gelatinous substance that is responsible for giving the eye its circular shape. Over the years, vitreous humor loses its consistency, becomes more liquid and can be detached from the back wall of the eye. This traction makes the vitreous humor pull the center of the retina and cause a macular hole. 
  • Eye trauma.
  • Retinal detachment.
  • Prolonged inflammation of the macula or macular edema.

 

Diagnosis

To diagnose the macular hole it is essential to assist the ophthalmologist to examine the fundus. The retinologist should dilate the pupil through eye drops and, after a few minutes, will proceed to study the fundus.

To make a correct diagnosis, it is necessary to make a optical coherence tomography, which allows the specialist to study the macula in greater detail to detect the presence of a hole in the tissue. It may also be the case in which the ophthalmologist asks to perform a retinography

The optical coherence tomography allows the doctor to know the stage of the macular hole, measure the thickness of the retina, know if there is a presence of fluid and a state of inflammation of the tissues of the back of the eye. 

macular hole vitrectomy

Macular hole treatment

During the first stages, the macular hole can be treated by applying medications through a intravitreal injection from Ocriplasmin

As the disease progresses and in most cases the Macular hole treatment is surgical. In this case, the pre-surgery examination applying all available ophthalmological means is vital to assess the state of the eye and the evolution of the disease to determine the surgical approach.

The procedure used to treat this type of disease is known as vitrectomy.

Vitrectomy

Vitrectomy is an eye surgery that has been used since 1991 to treat the macular hole. The procedure consists of remove vitreous humor and take it off the macula. The internal membrane of the retina, known as the internal limiting membrane, is also usually removed.

Once the vitreous and the internal limiting membrane have been removed, a gas bubble is introduced into the ocular structure which, upon contact with the macular hole, helps to close it. Thus ends the process of posterior vitrectomy.

Recovery of macular hole operation

In most cases, the Vision recovery time after a subsequent vitrectomy depends exclusively on the time of evolution or stage of the macular hole, and of the damage that said condition has caused in the macula. 

Postoperative macular hole

During the postoperative period of the macular hole, the patient can remain up to 8 days lying on your stomach, since this position allows the gas to come into contact with the hole and help close it. During the postoperative period of the macular hole tampor it is recommended to get on a plane and you should avoid all kinds of activity that puts pressure on the eye.

Once the postoperative period is over of vitrectomy, a new optical coherence tomography is performed to study the condition of the macula and verify that the hole has been closed correctly. One month after the operation, the patient can resume his normal life.

Your Order
Macular hole: what it is, operation and recovery time
Article name
Macular hole: what it is, operation and recovery time
Description
Did you know that the macular hole can cause irreversible damage to the macula?
Composer
Name of the editor
Área Oftalmológica Avanzada
Editor's logo