Macular hole: Causes, Symptoms and Treatment
What is a macular hole
A macular hole, also called a macular hole, is a condition in which there is a tear or opening in the macula, the central part of the retina. The macula is responsible for sharp vision and detail perception, essential for activities such as reading, driving and recognizing faces.
How does a macular hole occur?
A macular hole is usually caused by natural aging and associated posterior vitreous detachment. As we age, the vitreous in the eye shrinks and can detach from the retina. If too much tensile force is applied to the macula in the process, a tear or complete hole in the tissue can occur.
Other possible causes include eye trauma, high myopia or retinal diseases, such as diabetic retinopathy. A macular hole can also be hereditary in rare cases.
Impact on vision
Because the macula is responsible for central vision, a macular hole can affect vision in the center of the visual field. The severity of the disturbance depends on the size and stage of the hole. At an early stage, it may go undetected, while a fully formed macular hole causes significant vision problems.
Normal Macula
The macula is the center of the retina. Light rays are focused on this part. This part of the retina contains the greatest concentration of photoreceptors and is therefore responsible for perceiving details. The fovea (the center of the macula) is the most important part of the retina.
Macular Hole
The cause of the macular hole has to do with the vitreous and the posterior vitreous membrane. This vitreous will shrivel with age and so the posterior vitreous membrane becomes detached from the retina. Usually this happens without consequence to the retina but sometimes this creates a hole in the macula.
Symptoms of a macular hole: How do you recognize the condition?
A macular hole affects central vision and usually develops gradually. Symptoms depend on the stage of the macular hole and can vary in severity.
Common symptoms:
- Blurred or distorted vision(metamorphopsia), where straight lines appear crooked or wavy.
- Dark or gray spot in the center of the visual field, which may become larger.
- Reduced contrast and color perception, making colors appear duller.
- Difficulty reading or recognizing faces, especially in small details.
- Poorer vision in one eye, while the other eye can continue to function normally.
Because a macular hole often worsens gradually, early diagnosis is important to limit further damage. In case of sudden vision loss or distortion, it is advisable to consult an ophthalmologist immediately.
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Macular hole treatment: when is surgery necessary?
A macular hole causes blurred or distorted vision and usually does not close on its own. A vitrectomy is often the only effective treatment, depending on:
- Size and duration: Small holes can sometimes heal spontaneously, larger ones require surgery.
- Vision loss: If deterioration or problems with daily activities occur, intervention is required.
- Stage: In advanced stages, untreated macular holes lead to permanent vision loss.
During a vitrectomy, the vitreous is replaced with a gas bubble or silicone oil that presses the retina against the macula. A head-down position is often required after the procedure.
Success rate: 80-90% with timely surgery. The sooner treated, the better vision can recover. When in doubt, a consultation with an eye surgeon is crucial.
Treatment of macular hole: vitrectomy
The operation is a vitrectomy. Without surgery, vision will rapidly decline and be irreversibly impaired.
What is a vitrectomy
A vitrectomy is a surgical procedure performed to treat conditions in the vitreous and retina of the eye. The vitreous, a clear gel-like substance that fills the inside of the eye, is partially or completely removed during the procedure. This space is then filled with a special liquid, gas or silicone oil, depending on the type of treatment.
Vitrectomy is used for a variety of eye problems, including retinal detachment, macular surgery (such as an epiretinal membrane or macular hole), severe vitreous hemorrhage or infection, and complications of diabetes of the retina. Removing the vitreous allows the ophthalmologist better access to the retina to repair it or perform other treatments.
The procedure is usually performed under local anesthesia and takes an average of 20 to 60 minutes, depending on the complexity of the problem. Some recovery time may be required after surgery, depending on the filler used and the type of procedure. Vitrectomy is a safe and effective procedure that often leads to significantly improved vision or preservation of vision.
Recovery after macular hole surgery: What can you expect?
After a vitrectomy to treat a macular hole, a proper recovery process is essential for improving vision. Immediately after surgery, vision may be blurry due to the gas or air bubble placed in the eye to promote healing of the macula. This bubble gradually disappears within a few weeks.
Recovery period and posture
- Lying position: It is often advised to lie in a specific position for several days to a week, usually face down, to keep the gas bubble or silicone in the correct place.
- Limited activities: Intense exercise and flying are not recommended until the gas bubble dissolves.
- Drops therapy: Eye drops are prescribed to prevent infection and support healing.
When does vision improve?
Vision gradually recovers over several weeks to months. Factors such as the size of the macular hole and the duration of the problem before surgery affect the final result. Regular checkups with the ophthalmologist are important to monitor recovery closely.
Retinal surgeon: Dr. Bart Pion
Dr. Bart Pion, specialist in vitreoretinal surgery, is a leading retinal surgeon with years of experience in complex retinal surgery. He graduated magna cum laude from the Free University of Brussels in 2002, after which he specialized in retinal detachment, macular surgery and other advanced vitreoretinal procedures. Through continuous continuing education and participation in international conferences, he always stays abreast of the latest innovations in retinal surgery.
From 2010 to 2023, Dr. Pion was head of ophthalmic surgery at St. Peter's Hospital Brussels, where he spent 13 years performing the most complex eye surgeries and leading a team of more than 20 ophthalmic surgeons. During this time, he built a strong reputation in retinal surgery, cataract surgery and refractive treatments.
Here he performs vitrectomies, laser treatments and other innovative techniques to restore and protect his patients' vision. Focus Eye Clinic is the only extramural center in Belgium where retinal surgery is performed in an outpatient setting, offering patients fast and efficient treatment without hospitalization. His commitment to precision, innovation and the highest quality care makes him an authority in retinal surgery and vitreoretinal disorders.
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