Northeast Wisconsin Retina Associates

CLINICAL CONDITIONS

MACULAR HOLE

Macular hole is a common structural disorder of the macula. Macular hole formation occurs as a result of the vitreous undergoing shrinkage and contraction and exerting tractional force over the surface of the macula. When this process begins, the patient may notice blurred and/or distorted central vision. Once a macular hole forms, central vision declines further and since a defect is now present in the tissue, a blind spot may develop in the vision as well.

retina with macular hole

Macular hole often results in dramatic loss of central vision. Fortunately, surgical repair is possible in the substantial majority of patients and in most cases, ­significant recovery of vision can be achieved.

Surgery to repair a macular hole involves vitreous surgery (see Vitreous Surgery). In the case of a macular hole, a thin layer of transparent vitreous is adherent over the surface of the macula. This layer is identified and removed at the time of surgery. At the conclusion of the procedure, the eye cavity previously occupied by the vitreous is filled with a gas bubble. Following surgery the patient must maintain face downward positioning for a number of days in order to promote closure and healing of the macular hole. Initially, while the gas bubble remains large, vision is extremely limited and air travel is prohibited.

In comparison to 10–15 years ago, refinements in the surgical technique of macular hole repair have allowed retinal surgeons to utilize a much shorter acting gas bubble (two weeks versus six weeks) as well as shorter term positioning (often four to five days rather than two weeks). As in the case with most macular conditions, recovery of vision after macular hole repair is usually slow and gradual over a period of weeks or even months.

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