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Macular Hole

A macular hole is a discontinuity or break in the center portion of the retina, a part called the macula. The macula is responsible for the fine central vision used for reading or looking at distant objects. Macular hole is usually associated with ageing, but can also be caused by other eye disorders, trauma, epiretinal membrane and retinal detachment. Most macular holes slowly enlarge, giving rise to worse central vision as time passes. However, even left untreated, macular holes almost never result in complete blindness in the eye. A small percentage may resolve spontaneously during the early stages of the condition, but more than 90% of macular holes progress if untreated.

Cause

Macular holes usually occur due to stress on the macula. The eye is filled with a clear jelly called the vitreous. When one ages, the vitreous usually becomes more liquefied and may pull on the macula. This may result in a tear of the macula, forming a macular hole. Another cause of macular hole is high myopia, where the elongation of the eyeball puts stress on the macula, causing it to break. . Most patients who develop macular holes are in their 60’s or older. Most macular holes occur spontaneously although trauma can lead to holes in young patients. There is no known method of preventing macular holes. Diet, exercise and systemic disease do not appear to play a role in the development of this condition.

Symptoms

If a macular hole develops, the central vision is distorted or missing. The side or peripheral vision remains normal.There is no pain associated with a macular hole forming.

Treatment

Macular hole and epiretinal membrane can be treated with a vitrectomy, a form of keyhole surgery that uses small probes to enter inside the eye to remove the vitreous and peel off the epiretinal membrane. A gas is then injected into the eye to replace the vitreous and prevent it from pulling on the retina. Following surgery, the patient will need to lie in a face-down position for one to two days to allow the gas bubble to press against the macula to smoothen it. The eye will refill naturally with fluid. This surgery is usually done as a day (outpatient) surgery using a local anesthesia, and takes up to an hour.

Postoperative care

A patch is worn over the eye until the morning after surgery. Eye drops (an anti-inflammatory and an antibiotic) are then used several times each day for up to 4 weeks after surgery. Patients can usually resume normal non-strenuous physical activities the day after surgery. How quickly the patient can drive, return to work, perform fine visual tasks, or engage in strenuous activities will vary from person to person.

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