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Guide to Macular Holes

Macular Holes What is the macula?
The macula is a very small area in the center of the retina. This area is extremely sensitive with a high concentration of photoreceptor cells. The macula is responsible for the highly detailed center of our field of vision, and is crucial for tasks such as reading and face recognition.

What is a macular hole and who is at risk?
A hole can develop in the macula, resulting in blurry, distorted vision. This vision loss can be sudden or can occur gradually. In the beginning, the person may notice that straight lines or objects appear bend or look wavy.

There are 3 stages of macular holes: foveal detachments, partial-thickness holes, and full thickness holes. As the condition progresses, it is more likely to worsen without treatment. An untreated macular hole can also lead to retinal detachment, a serious condition that can cause permanent blindness.

Macular holes are more common in people over 60, and women have a slightly higher risk than men. (Note that this is not the same as macular degeneration, although symptoms are similar.) Once you've had a macular hole in one eye, there is a 10-15% chance that one will eventually develop in your other eye.

Causes of macular holes
The most common cause of macular holes is vitreous shrinkage and/or separation. The vitreous humor is the clear, gel-like substance that fills the inside of the eye and is attached to the retina with thin strands of cells. As we age, the vitreous shrinks and can begin pulling on the retina, sometimes even tearing off part of it. If this damage occurs within the macula, it is called a macular hole.

Vitreous shrinkage can also cause damage more indirectly. Sometimes the connecting strands break away from the vitreous, but remain connected to the retina. When these strands contract, a macular hole can develop from the tension.

Other causes of macular holes include:

  • Extreme myopia (nearsightedness)
  • Macular picker
  • Retinal detachment
  • Diabetic retinopathy
  • Best's disease
  • Eye injury

The most common treatment for macular holes is a surgery called a vitrectomy, in which the vitreous humor is removed, and a mixture of gases is injected into the eye to replace it. This gas bubble acts like a bandage, putting pressure on the edges of the hole, allowing them to heal properly.

After surgery, the patient must lie face down for at least a day or two, sometimes as long as two or three weeks. This position is crucial, as it keeps the bubble in place against the macula.

Over time, the body gradually absorbs the bubble, and the space is filled with natural eye fluids. The patient will not be able to travel by airplane for several months following surgery. Pressure changes during flight could cause any remaining gas within the eye to expand, causing eye damage.

Like any surgery, there are risks associated with vitrectomy, the most common of which is cataracts. According to one study, the treated eye is 59% more likely to develop a cataract than the untreated one, often rather quickly, but the cataract can be removed once the eye has healed. Other possible complications include infection and retinal detachment.

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