Reasons and treatments for macular holes

Thursday, November 12th, 2009 at 5:24 pm Post in Eye Diseases

Both macular holes and macular degeneration happen more frequently to people above 60. However, they are not the same. Macular holes occur on the macula, which is situated in the center of retina and responsible for clear, color vision. The macula has a sharp point that is critical for some activities such as driving and recognizing faces.

Contents of the macula include cones and rods. Rods see black and white shading, shape and movement. Macular holes can cause sudden vision decrease in one eye. People’s natural aging brings some changes in the macular contents, so that old people are more susceptible to macular holes. Other reasons for macular holes include vitreous shrinkage or separation, diabetic eye disease, heavy myopia, detached retina, Best’s disease and certain eye injuries.

Vitreous shrinkage is a major contributor to macular holes. The shape of the eye is maintained by the thick vitreous humor in the back eye, so that aging-caused vitreous shrinkage will pull on the retina. In serious cases, this shrinkage can tear a chunk off of the retina, resulting in a hole. The same situation on macula is called a macular hole. Another direction reason for macular holes is the detachment of cell’s strands that ever connected the vitreous humor and the retina. These strands then contract around the macula, causing macular holes. Both of the two situations bring fluids by vitreous shrinkage, which fill the macular holes and cause blurry and distorted vision.

Macular holes have three stages and most of them require external intervention. Without treatment, about 50% of foveal detachments worsen and 70% of partial-thickness hole worsen, while most full-thickness holes worsen.

For macular hole treatment, the best way is to remove the vitreous gel to stop it from pulling on the retina. A vitrectomy is the right procedure, during which the specialist will also insert a bubble of air and gas into the vitreous space, in order to put pressure on the macular hole’s edges and heal it. This process takes as long as two to three weeks, because you should lie face down so that the bubble stays in the right place in the eye. The bubble goes away over time and eye fluids will restore.

Risks of a vitreous surgery include infection, retinal detachment and cataracts. Cataracts can occur immediately after a vitrectomy. Patients who have received a vitrectomy using a gas bubble should avoid air travel within several months, because pressure changes in the plane may cause gas expansion.