What is a macular hole and its causes
A macular hole is a defect or rupture of tissue located in the central area of the macula, the so-called fovea, which causes a central vision defect (scotoma) or an area of blurred vision in the center of the visual field. It is a macular hole because it occurs in the macula, the anatomical structure of the retina responsible for central vision, i.e. the vision we use when reading, watching television or recognizing faces.
Although they usually appear with age, macular holes can be secondary to ocular trauma. When they appear with age, it is because over the years a process of degeneration of the vitreous humor, adhered to the retina, which may eventually contract and detach from the retina. One of the areas to which it is most adherent is the macula and it is when these contractions occur that a macular hole can occur.
The main risk factor for macular hole is age, but it also occurs in patients with myopia greater than six diopters, patients with ocular trauma and patients who have had a macular hole in their other eye (10-15% higher risk).
There are mainly two types of macular holes, complete macular holes and lamellar macular holes. In the first case, complete macular holes affect all the layers of the retina and lead to a greater loss of vision. Lamellar macular holes affect only a few layers of the retina and not so much vision. These lamellar macular holes may be associated with epiretinal membranes.
Macular hole symptoms
The symptoms related to macular hole start gradually, at the beginning we may find the vision slightly distorted or a fog in the center of vision. With the evolution, vision worsens and distortion in straight lines and, above all, loss of reading ability may be noticed until at the end of the process it may become very difficult to perform any central vision task with the affected eye.
Treatment of macular hole
A complete ophthalmological examination including the following tests is essential: retinography, autofluorescence, optical coherence tomography and, if necessary, microperimetry. Although some macular holes in the early stages may close on their own, the vast majority of cases require microsurgery.
The surgical procedure consists of performing a posterior vitrectomy to remove the vitreous gel from inside the eye, remove the posterior hyaloid and dissect and remove an extremely thin membrane called the internal limiting membrane to facilitate the relaxation of the retina so that the lips of the macular hole can reattach to the pigment epithelium. The eye is then filled with gas to maintain pressure on the retina and allow the macular hole to close. Macular hole surgery is performed under local anesthesia and the patient can return home after the procedure.
At the Institut de la Màcula i de la Retina we have the most advanced technology for macular hole treatment and the latest innovations in the field of vitreoretinal surgery, which allows us to obtain a very high rate of anatomical closure of the macular hole.