What is a macular hole and its causes
The macular hole is a defect or tissue break located in the central area of the macula, the so-called fovea , which causes a central vision defect (scotoma) or a blurred vision area in the center of the visual field. It is a macular hole because it occurs in the macula , the anatomical structure of the retina responsible for central vision, that is, the vision we use when reading, watching television or recognizing faces.
Although they usually appear with age, macular holes may be secondary to eye trauma.. When they appear with age it is because over the years there is a process of degeneration of the vitreous humor, attached to the retina, which can end up contracting and detaching from the retina. One of the areas to which is more attached is the macula and when these contractions occur is when a macular hole can occur.
The main risk factor of the macular hole is age, but it also occurs in patients with myopia greater than six diopters, patients with eye injuries and patients who have had a macular hole in their other eye (10-15% more risk).
There are mainly two types of macular holes, the complete macular holes and lamellar macular holes. In the first case, the complete macular holes affect all the layers of the retina and lead to a greater loss of vision. Regarding the lamellar macular holes affect only a few layers of the retina and not so much to the vision. These lamellar macular holes may be associated with epiretinal membranes.
Symptoms of the macular hole
The symptoms related to the macular hole begin gradually, at first we can find the slightly distorted vision or a fog at the center of vision. With evolution, vision worsens and distortion can be noticed in straight lines and, above all, loss of reading ability until at the end of the process it can become very difficult to perform any central vision task with the affected eye.
Macular hole treatment
A complete ophthalmological examination including the following tests is essential: a retinography, an autofluorescence, an optical coherence tomography and, if necessary, a microperimetry.. Although some macular holes in initial stages can be closed alone, the vast majority of cases require microsurgery.
The surgical procedure consists of performing a posterior vitrectomy to remove the vitreous gel from inside the eye, remove the posterior hyaloid and dissect and extract an extremely thin membrane called the internal limiting membrane, to facilitate the relaxation of the retina and the lips of the hole. macular can sit back on the pigment epithelium. Then the eye is filled with gas so that it maintains a pressure on the retina that allows the macular hole to close. Macular hole surgery is performed under local anesthesia and the patient can return home after the intervention.
At the Institut de la Màcula i de la Retina we have the most advanced technology for the treatment of the macular hole and the latest innovations in the field of vitreoretinal surgery, which allows us to obtain an anatomical closing rate of the very high macular hole.