The macula is the central part of the retina and is responsible for our detailed visual acuity. When a full-thickness retina defect develops in the central macula, this is referred to as a macular hole. These most often occur spontaneously, without an obvious cause. They are most common in women over the age of 55. If a macular hole develops in one eye, there is a 10-15% risk of one developing in the other eye as well. The most common cause of a macular hole is separation of the vitreous gel that fills the back of the eye. On some people this gel remains adherent to the central fovea and traction on the retina creates the hole. Other, less common causes include: trauma, high myopia (near-sightedness), diabetic retinopathy, or epiretinal membrane.
Vitrectomy surgery is the most common treatment for macular holes. In this surgery, micro-incision are made in the white part of the eye and the vitreous gel is removed from the posterior cavity of the eye. The inner-most layer of the retina is peeled to increase the elasticity of the retina and a gas bubble is left in the eye. The patient is usually asked to maintain a face-down position for 3-7 days to allow the gas bubble to hold the edge of the macular hole together until it heals. The gas bubble will go away on its own after a couple of weeks. Surgery will successfully close a macular hole, ~95% of the time, with patients regaining most of their lost vision. Another recent potential treatment is the injection of a medicine called Jetrea in the eye. It can help relieve persistent vitreous traction, when evident, and allow closure of the hole without surgery. Sometimes very small macular holes can be observed if they are not visually significant. In these cases regular follow-up examinations would be important.