The Problem
Macular Hole
A macular hole is a small gap that opens at the center of the retina, in an area called the macula.
The retina is a thin layer of tissue lining the back of the eye, which senses light, like the film in a camera. In the center of the retina is the macula, which is essential for reading, recognizing faces, and seeing details clearly.
The very central vision is one of the thinnest points in the retina. The hole in the central vision is thought to occur due to the vitreous gel that fills the eye, pulling on the retina and leading to this thin area to separate into a hole. A macular hole is a physical hole in the area of central vision, called the macula. When small, a macular hole results in a modest reduction in vision. Over time it tends to enlarge and can result in a profound loss of central vision. In general, any full thickness macular hole would benefit from intervention.
When a macular hole forms, it can cause distorted or blurry vision, especially in the center of your sight. You might notice a dark or blank spot in your vision, or straight lines might appear crooked or wavy.
The good news is that there is treatment available for macular holes. A common procedure called a vitrectomy is done, where a surgeon removes the vitreous gel that pulled on the macula and caused the hole. A film on the back of the eye is then peeled to allow the retina to relax and for the hole to close. Then, a special gas bubble is placed inside the eye to help the hole heal. This surgery can often improve or restore vision. However, I counsel patients that it is never perfect. Although most have great improvement, patients will often still have some distortion or reduced vision. Rarely, the hole does not close. This is more common if the hole has been present for a long time, typically longer than a year.
The Procedure
Vitrectomy and Membrane Peeling
Vitrectomy is the technique for surgical treatment of macular holes. It involves making three small ports in the eye. These ports are so small that they usually do not require any stitches to close as they self-seal. One port is for an infusion fluid to keep the eye pressure, while the other ports are used to introduce a light and a cutter. The light allows the surgeon to see into the inside of the eye through a microscope. The cutter is used to remove the vitreous gel which is attached to the retina. By fully removing the gel, the traction pulling on the macular hole is removed. Once the gel is removed, small forceps and high microscope magnification are used to peel off a retinal film that helps decrease the traction on the macular hole. The eye is then filled with gas to help push the hole closed.
After surgery, patients must keep their heads down for four days. Patients can take a 5-minute break every hour.
Risks?
Complications of vitrectomy include: a 1 in 1,000 risk of bleeding or infection, a 1 to 2% chance of retinal tears or detachment which is fixed at the same time, although it can occur after surgery and would require a second surgery to repair. There is a high risk of cataract should one not have already had cataract surgery. Cataract surgery can always be done in the future should this occur. Cataract surgery is very safe and the most common of all performed surgeries. Sometimes the pressure can be high or low right after the surgery. If it is high, drops can be used to treat it. Low pressure usually will resolve on its own.
Overall, this is a very safe procedure.
Dr. Adatia will speak to you about your individual risk when consenting you for surgery.