What is the Treatment for a Macular Hole?

A macula is located in the back of the eye and is a part of the retina system. The macula allows us to see color, images, and details clearly as part of our central vision.

Due to age and other factors, a hole can develop in the macula. Early in the development of a macular hole, individuals will notice blurriness as they look straight ahead and objects can appear wavy making reading, driving, etc. very difficult. 

The environment of the eye is such that its interior is filled with a gelatinous substance whose main function is to help the eye keep its round shape.

This gel-like substance is called “vitreous.” The vitreous contains fibers that attach to the retina. Unfortunately, as we age, the vitreous begins to shrink, thus pulling away from the surface of the retina. 

Clear vision is then replaced by multiple specs or distorted images that float, thus interfering with vision.

When the vitreous pulls away from the retina, it can cause a hole where other body fluids can enter and distort our central vision. 

A macular hole is not a macular degeneration issue which also happens due to aging. Other macular hole problems aside from aging can occur due to diabetic eye disease, myopia, inherited disease called Best disease and also from an injury. 

A macular hole will sometimes repair itself, but an ophthalmologist should still give you an examination. If a macular hole is not treated, it will become worse. There are three different stages of holes:

There are three different stages of Macular Hole:

  • Foveal detachments – beginning eye problem – Stage I
  • Partial-thickness holes – is fast becoming worse – Stage II
  • Full-thickness holes – a surgical procedure is needed – Stage III

In order to fix a macular hole, a surgery called a “vitrectomy” is performed. This is one of the 2019 macular hole treatments. A test for a macular hole is the optical coherence tomography or OCT. 

It is a non-invasive imaging solution using low reflected lighting to view the eye’s retina. An ophthalmologist is a surgical specialist who will remove the vitreous that is pulling on the macula. 

A gas bubble is placed inside the eye that is designed to flatten the macular hole and keep it held in place as the eye naturally heals.

No, the gas bubble does not need to be removed, it will disintegrate and regular eye fluid will return. It is at this point that patients are advised not to fly.

The reason is due to the changes in air pressure that may expand the eye bubble. This is a painful experience as the pressure inside the eye increases.

Following this vital surgery procedure, patient’s are also told to lie face-down for several days or a couple of weeks. The reason is to allow the bubble to dissolve where the eye’s natural fluid can return. 

As one of the 2019 macular hole treatments, a vitrectomy has a 90% success rate whereby the patient will regain most of their lost vision. Thanks to advanced technology, the success of a vitrectomy is due to improvements in surgical techniques that involve the tomography of the eyes.

The visual outcome also depends on how large the hole was in the beginning and how long the patient had the hole prior to surgery. 

Another one of the 2019 macular hole treatments is an injection. A specialized ocriplasmin enzyme is injected into the vitreous.

The result of using this treatment is to help some patients relieve vitreous traction on the macular hole. Administering the injection is pretty simple and patients can return home.

Vision improvement will vary. People who have had a macular hole for less than six months have a great vision recovery. The length of time for vision recovery can be up to three months after the surgery.

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