What is the Macula?
The macula is the central area of the retina where fine-detail vision for reading, recognizing faces, and driving is located. The retina is the light sensitive inner lining in the back of the eye that is like the film in a camera. Anatomically, the macula is located in the straight ahead position of the eye and is at the center of the retina. If the retina were a target, the macula would be the bull’s eye. Although the macula is a small portion of the total retina, it is the most important area for the precise visual tasks required of modern life.
What is a Macular Hole?
A macular hole is the result of abnormal interaction between the vitreous gel inside the eye and the macula, the central area of the retina providing center vision. This occurs due to abnormal tangential traction on the macula. The traction in a macular hole is likened to pulling on the edges of a button hole. As the fabric is pulled apart, the hole gapes open. By removing the pulling forces on the macula, we allow the tissue to come back together, eliminating the gape, thereby closing the hole. Patients with a macular hole in one eye have a 14% chance of developing a macular hole in their other eye.
What are symptoms of a macular hole?
The initial symptoms of macular holes include blurring of vision and distortion. As the hole opens further, a central blind spot can develop resulting in increased difficulty with reading and seeing fine details.
What are treatment options for a macular hole?
Treatment depends on the stage and size of the macular hole. Observation of small and recent macular holes is often recommended, since occasionally they will resolve spontaneously. For older, larger and progressively enlarging macular holes, surgery is required to restore vision and prevent further visual loss. Surgical and visual success is best if the eye is operated on within the first 3 months of onset.
What is vitrectomy surgery for a macular hole?
To repair the hole, your surgeon will perform vitrectomy surgery and remove a fine layer of the retina known as the internal limiting membrane. Removal of this tissue has been associated with a higher rate of hole closure and a lessened risk of hole re-opening. With this technique, there is about a 95% chance of successful hole closure with a single surgery.
At the end of the surgery, your surgeon will place a gas bubble in the eye. At this point, proper head positioning helps to ensure successful healing. You will likely be asked to maintain a face-down position for the first week. This position places the gas bubble over the hole to help prevent reopening. Your body will absorb this gas bubble over the course of about 3-6 weeks. As long as the gas bubble is in the eye, you should avoid laying flat on your back. The vision will be blurred, and you will be restricted from flying, traveling to high altitude, and scuba diving as this can lead to the dangerous elevation of eye pressure from expansion of the bubble. With recurrent or especially difficult macular holes, silicone oil may be substituted for intraocular gas or a blood patch made from the patient’s own plasma may be useful.
Do you need face down positioning following macular hole surgery?
Successful closure of the hole has been reported without face down positioning. The success rate is slightly less than with face-down positioning, yet still quite good. At Retina Associates of Florida, we believe in tailoring surgery to the needs of our patients. If you are interested in undergoing macular hole surgery without face-down position, let your surgeon know so we can discuss whether you would be a favorable candidate.
