Macular holes usually occur due to stress on the macula. The eye is filled with a clear jelly called the vitreous.
The vitreous usually becomes more liquefied as we age and may pull on the macula. This can result in a tear of the macula, forming a macular hole.
Another cause of macular hole is high myopia, where the elongation of the eyeball puts stress on the macula, causing it to break. Most patients who develop macular holes are aged 60 or older. Most macular holes occur spontaneously although trauma can lead to holes in young patients. There is no known method of preventing macular holes. Diet, exercise and systemic disease don’t appear to play a role in the development of this condition.
Macular hole symptoms
If a macular hole develops, the central vision is distorted or missing. The side or peripheral vision remains normal. There is no pain associated with a macular hole forming.
Macular hole treatment
Macular hole and epiretinal membrane can be treated with a vitrectomy, a form of keyhole surgery that uses small probes to enter inside the eye to remove the vitreous and peel off the epiretinal membrane. Gas is injected into the eye to replace the vitreous and prevent it from pulling on the retina. Following surgery, the patient must lie face down for one to two days to allow the gas bubble to press against the macula to smoothen it. The eye will refill naturally with fluid.
Macular hole postoperative care
A patch is worn over the eye until the morning after surgery. Eye drops (an anti-inflammatory and an antibiotic) are prescribed several times each day for up to four weeks after surgery. Usually patients can resume normal non-strenuous physical activities the day after surgery. How quickly the patient can drive, return to work, perform fine visual tasks, or engage in strenuous activities will vary from person to person.