Definition: A macular hole is a gap in the centre of the retina. It is commonly found in 'hypermetropic' or long-sighted patients. Sometimes, 'high myopes' or very short-sighted patients can also develop this. It can also develop from trauma or retinal detachment surgery, but this is rare.
Symptoms: Patients will experience distortion of images, bending of straight lines, a gap in the centre of the vision, and/or blurred vision.
Treatment: Macular holes can be repaired surgically. This involves a 'vitrectomy' (removing the vitreous gel), peeling the surface layer of the retina, and gas injection into the vitreous cavity of the eye. Gas will usually last between 4-8 weeks and it will gradually disappear by itself. Posturing by keeping the face down, looking at the floor, can aid the closure of holes which are large, but this usually is not necessary in smaller holes. Your surgeon will discuss what is involved and if this is required before your operation. This can be performed as a day case procedure with the patient either awake or asleep.
Outcome: 90% of normal sized macular holes will close with surgery. Larger and longer standing holes have a lower chance of success. The operation usually improves the distortion, double vision, and reading. Sharpness in vision will also improve, but it typically does not improve to a level when the eye did not have the condition.
The condition is not a blinding condition and therefore urgent treatment is not necessary. However, macular holes can progress and therefore should be operated on sooner rather than later.
Innovation: A pioneering innovation in closing large macular holes has been studied by our vitreoretinal expert. He has published this new technique (RETMA) in the medical literature which has been successful in closing previously untreatable, large macular holes. The technique was also presented at the World Ophthalmological Congress in Tokyo 2014.
Macular hole OCT vs Normal OCT