What Causes a Macular Hole?

Increasing age is the most common risk factor for the development of a macular hole.

With increasing age, the vitreous gel that fills the eye begins to shrink and condense. This results in the gel pulling away from it’s strong attachment to the center of the retina.

The gel pulling away is a natural process that usually occurs without any problems. However, occasionally the vitreous can stick to the retina and pull a hole.

Besides age, other retinal diseases and trauma can cause a macular hole to form.

How is a Macular Hole diagnosed?

A dilated eye exam is needed to diagnose a macular hole.

Your ophthalmologist will use special lenses to examine the retina.

Special pictures called optical coherence tomography (OCT) aid in the diagnosis of a macular hole.

The OCT is a machine that non-invasively scans the back of your eye and provides microscopic images of the retina and macula. OCT scans can diagnose macular holes as well as other retinal diseases.

How is a Macular Hole treated?

Sometimes a small macular hole can heal on it’s own. However, most macular holes require surgery.

The surgery is called a vitrectomy with membrane peel, and it is the best way to treat a macular hole.

During a vitrectomy with membrane peel, your retinal surgeon removes the vitreous that is pulling on your macula and removes a fine layer of tissue on the surface of the retina to aid in hole closure.

During surgery, a gas bubble is left inside the eye and helps flatten the macular hole and support the retina while it heals. The gas bubble will dissolve over a period of several weeks.

What to expect with vitrectomy surgery for macular hole:

• Mild pain or discomfort after surgery.


• An eye patch needs to be worn at night to protect the eye. Eye drops will also be needed for several weeks.


• Macular hole surgery often requires a face down or reading position at all times for up to a week after vitrectomy surgery. The positioning keeps the gas bubble in the ideal location to allow the retina to heal properly.


• As a result of the gas bubble, you cannot fly in an airplane until it dissolves completely. You cannot fly in an airplane until the gas bubble has dissolved. Flying before the bubble is gone can result in a rapid increase in eye pressure and a permanent loss in vision.


• The gas bubble can also react to different anesthesia, so if you need to have any other type of surgery, be sure to tell your doctor.


• Your vision will usually improve with the closure of the macular hole. Maximal improvement may take several months. Final vision after hole closure depends on the size of your macular hole prior to surgery and how long the hole was there before you had surgery.

What are Vitrectomy Surgery risks?

Like any surgery, vitrectomy surgery has risks.

• Infection.


• Bleeding.


• A retinal detachment.


• Glaucoma, or increased eye pressure.


• Cataract, cloudiness of the lens.

Your ophthalmologist will talk about these risks and how vitrectomy surgery may help you.

A macular hole is a hole in the center of your retina

and affects your central vision.

It is treated with a surgery called vitrectomy with membrane peel.