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Diabetic retinopathy | Macular
hole | Posterior vitreous detachment |
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Retinopathy of prematurity
MACULAR HOLE
Other Names:
Macular cyst, retinal
hole, retinal tear, and retinal perforation.
What is a macular hole?
A
macular hole is a small break in the macula, located in the center of the
eye's light-sensitive tissue called the retina. The macula provides the
sharp, central vision we need for reading, driving, and seeing fine detail.
A
macular hole can cause blurred and distorted central vision. Macular holes
are related to aging and usually occur in people over age 60.
Is a macular hole the same as age-related
macular degeneration?
No.
Macular holes and age-related macular degeneration are two separate and
distinct conditions, although the symptoms for each are similar. Both
conditions are common in people 60 and over. An eye care professional will
know the difference.
What causes a macular hole?
Most of
the eye's interior is filled with vitreous, a gel-like substance that fills
about 2/3 of the eye and helps it maintain a round shape. The vitreous
contains millions of fine fibers that are attached to the surface of the
retina. As we age, the vitreous slowly shrinks and pulls away from the
retinal surface. Natural fluids fill the area where the vitreous has
contracted. This is normal. In most cases, there are no adverse effects.
Some patients may experience a small increase in floaters, which are little
"cobwebs" or specks that seem to float about in your field of vision.
However, if the vitreous is firmly attached to the retina when it pulls
away, it can tear the retina and create a macular hole. Also, once the
vitreous has pulled away from the surface of the retina, some of the fibers
can remain on the retinal surface and can contract. This increases tension
on the retina and can lead to a macular hole. In either case, the fluid that
has replaced the shrunken vitreous can then seep through the hole onto the
macula, blurring and distorting central vision.
Macular
holes can also occur from eye disorders, such as high myopia
(nearsightedness), macular pucker, and retinal detachment; eye disease, such
diabetic retinopathy and Best's disease; and injury to the eye.
What are the symptoms of a macular hole?
Macular
holes often begin gradually. In the early stage of a macular hole, people
may notice a slight distortion or blurriness in their straight-ahead vision.
Straight lines or objects can begin to look bent or wavy. Reading and
performing other routine tasks with the affected eye become difficult.
Are there different types of a macular hole?
Yes, they fall into the following categories:
·
Classic
macular holes: also called idiopathic or degenerative macular holes, these
are much more common than other types. These are of the type that will
likely benefit most from surgery, if certain criteria are met.
·
Traumatic
macular holes: these usually occur with direct impact occurring on the eye
or head. Some of the traumatic cases spontaneously heal ("close" or "seal").
Surgery is less successful in this group but can be performed if the doctor
thinks the retina and underlying
retinal pigment epithelium are
functioning well.
·
Macular holes
caused by long-standing macular edema (swelling), which can be caused by
diabetic retinopathy, branch vein occlusion, pars planitis, or other
inflammatory eye disease. Patients with holes of this type should not be
treated with surgery.
How is a macular hole treated?
Although some macular holes can seal themselves and require no treatment,
surgery is necessary in many cases to help improve vision. In this surgical
procedure--called a vitrectomy--the vitreous gel is removed to prevent it
from pulling on the retina and replaced with a bubble containing a mixture
of air and gas. The bubble acts as an internal, temporary bandage that holds
the edge of the macular hole in place as it heals. Surgery is performed
under local anesthesia and often on an out-patient basis.
Following surgery, patients must remain in a face-down position, normally
for a day or two but sometimes for as long as two-to-three weeks. This
position allows the bubble to press against the macula and be gradually
reabsorbed by the eye, sealing the hole. As the bubble is reabsorbed, the
vitreous cavity refills with natural eye fluids.
Maintaining a face-down position is crucial to the success of the surgery.
Because this position can be difficult for many people, it is important to
discuss this with your doctor before surgery.
What are the risks of surgery?
The
most common risk following macular hole surgery is an increase in the rate
of cataract development. In most patients, a cataract can progress rapidly,
and often becomes severe enough to require removal. Other less common
complications include infection and retinal detachment either during surgery
or afterward, both of which can be immediately treated.
For a
few months after surgery, patients are not permitted to travel by air.
Changes in air pressure may cause the bubble in the eye to expand,
increasing pressure inside the eye.
How successful is this surgery?
Vision
improvement varies from patient to patient. People that have had a macular
hole for less than six months have a better chance of recovering vision than
those who have had one for a longer period. Discuss vision recovery with
your doctor before your surgery. Vision recovery can continue for as long as
three months after surgery.
What if I cannot remain in a face-down
position after the surgery?
If you
cannot remain in a face-down position for the required period after surgery,
vision recovery may not be successful. People who are unable to remain in a
face-down position for this length of time may not be good candidates for a
vitrectomy. However, there are a number of devices that can make the
"face-down" recovery period easier on you. There are also some approaches
that can decrease the amount of "face-down" time. Discuss these with your
doctor.
Is my other eye at risk?
If a
macular hole exists in one eye, there is a 10-15 percent chance that a
macular hole will develop in your other eye over your lifetime. Your doctor
can discuss this with you.
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Please call your local eye care
professional for more information.
There are several ways of reaching the ophthalmologists of the
EYE REPUBLIC Ophthalmology Clinic:
-
Visit the EYE REPUBLIC
Ophthalmology Clinic website at
EyeRepublic.com.ph.
-
Visit the Ophthalmic
Consultants Philippines Co. website at
OCP.com.ph.
-
Email
help@EyeRepublic.com.ph for
general inquiries. After writing down your comments,
suggestions, problems and/or questions, kindly tell us how
to get in touch with you by providing your name, email,
home/office numbers, and mobile phone.
-
Place a blog
comment at the
EYE REPUBLIC Blog.
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EYE REPUBLIC
Ophthalmology Clinic
Manila
3/F Don Santiago
Building (DSB) Units 309-310
1344 Taft
Avenue, Ermita
Manila,
1000 Philippines
Direct and Fax: +63 (2)
536-2398
Trunk line: +63 (2) 523-8271 to 79 local 30
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Map and directions
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EYE REPUBLIC
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Asian Hospital
and Medical Center
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Map and Directions
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EYE REPUBLIC
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Medical City
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Medical Arts Tower (MATI) Suite 602
MERALCO Compound, Ortigas
Ave.
Pasig City,
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Map and Directions
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EYE REPUBLIC
Ophthalmology Clinic
St. Luke's
Medical Center
6/F
Cathedral Heights Building Complex (CHBC) North
Tower Suite 614
279 E. Rodriguez
Sr. Boulevard
Quezon City, 1102
Philippines
Direct and Fax:
+63 (2) 407-3883
Cellular line: +63 (917) 855-2020
Map and directions
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CLINIC HOURS
Monday to Saturday 9:00 AM to 6:00 PM
All clinics are
closed on
Sundays and Holidays
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