Macular hole is a condition where there is a defect in the central part of the retina.
This results in blurred or distorted central vision. This is the vision that is used to see detail (reading, recognising faces), so a problem in this area can be quite disabling. If left untreated, the vision tends to deteriorate over a period of months.
The treatment for macular hole is vitreoretinal surgery. This involves removal of the vitreous and then insertion of a bubble of gas (sulphur hexafluoride or perfluoropropane) into the posterior chamber of the eye. Often a membranous layer is also peeled from the surface of the retina. This is thought to improve hole closure rates.
Following surgery patients sometimes have to posture with their face down for a period of time. This, however, is becoming increasingly unpopular as many patients find posturing face down quite uncomfortable and inconvenient. There is increasing evidence to suggest that posturing may not be necessary and hole closure rates can be maintained without posture.
Directly after surgery the vision is poor because of the gas bubble in the eye. This bubble takes a few weeks to disappear and as it does, the vision returns. Approximately 90% of patients have successful surgery ie. the hole closes. The final visual outcome is a less predictable, but patients who are operated on early and have small holes tend to do better. The majority of patients have much better vision and reduced distortion after surgery. Complications are uncommon, but as with all surgery, possible.
Optical Coherence Tomograph (OCT) (cross section) of the normal macula
OCT of macular hole. Note the "missing" area in the centre
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