Macular Hole

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    The macular hole is one of the common eye diseases among people over the age of fifty. It affects the visual center in the eye, known as the retina. The vitreous at the back of the eye begins to shrink and decay as a person becomes older, causing it to detach from the retina and possibly cause a rupture in the retina.

    Patients can still see things clearly, but when they develop blurred vision or feel dark opacity in some areas, the space between the vitreous body and the retina could be full of fluids secreted by the eye. This causes blurry vision and requires an immediate visit to a doctor to examine the fundus of the eye and identify the problem.

    What Does Macular Hole Mean?

    The retina is the thin layer that forms the images in the center. Healthy people can see images clearly. When the retina has a macular hole, distortions in vision happen due to the dimming of some areas. This condition goes through four stages, and the earlier the diagnosis, the more effective the treatment. But if retinal detachment occurs, there is a high possibility that the patient will lose vision completely.

    Types of Macular Hole

    There are two types of macular holes:

    Complete Macular Hole

    This causes a tear in all layers of the retina and leads to a significant decline in the patient's vision.

    Lamellar Macular Hole

    This affects some layers of the retina, but not all, and its damage to vision is limited compared to a complete macular hole.

    Causes of Macular Holes

    • Getting old is the most important cause of developing holes in the center of vision. When a person is over fifty, doctors expect atrophy to happen in the gel-like fluid covering the retina, causing it to separate from the retina and stick to the macular hole, leading to a tear in the retina.
    • This hole may also occur due to an enlarged macula because of another eye disease.
    • Anyone who has been previously injured in the head or around the eye.
    • People with weak retinas are more likely to develop macular holes.
    • There are other reasons, such as being overweight and exposure to the sun for too long, which increases the risk of macular holes or retinitis.

    Macular Hole Diagnosis

    At first, the doctor uses fluid drops to dilate the pupil of the eye, so that it becomes easier to look at the fundus of the eye through a certain device (OCT). Then he takes cross-sectional images of the area behind the eye (the retina) to identify the locations of retinal infections and the extent of the macular hole.

    Doctors can also use ultrasound if faced with a problem during retina examination, such as a blood vessel hemorrhage.

    Risk Factors of Macular Hole

    • The most prominent factor is aging. Studies have proven that the number of elderly people over the age of sixty who have macular holes has exceeded 8 million citizens in the United States.
    • People who have eye disease are more likely than others to develop retinitis.
    • People who primarily suffer from nearsightedness.
    • Patients who have a macular hole in one eye are more likely to develop the same condition in the other eye.
    • Diabetics or those who have a diabetic retinal detachment. Also, those who have a problem with blood flow within the vessels of the retina.

    The Main Symptoms of Macular Holes

    • At first, the patient only has blurry vision, so they cannot see the images with their eyes, whether while reading or driving. They also see zigzag lines instead of straight lines. This increases the possibility of injuries and accidents.
    • In the next stage, the patient notices a missing part in the images that reach their eyes.
    • Women are more likely to develop macular holes than men.

    The Most Common Problems of the Retina

    The retina contains millions of cells that are sensitive to light and millions of neurons that have an important role in sending nerve messages to the brain so that you can identify the images. There are many diseases that affect the retina and lead to blurry vision. They can also lead to a complete loss in many cases. Here is a brief mention of these diseases:

    Retinal Tear

    This tearing occurs when atrophy develops in the transparent substance known as the vitreous body, which connects the retina by thin ligaments. As the fluid decreases, it stretches the retina and changes its position, which prevents the light from entering the center of the retina, and thus the images appear floating and blurred.

    Retinal Detachment

    This separation or detachment occurs because of fluid entering the space below the retina after a retinal tear.

    Diabetic Retinopathy

    This happens in diabetic people when the capillaries at the back of the eye become weak or susceptible to bleeding, causing fluid to enter the bottom of the retina, which makes it swell and causes blurry vision.

    Macular Hole

    As mentioned before, a macular hole occurs because of the separation between the retina and the vitreous body. This happens in the center of the retina, which greatly affects the clarity of central vision.

    Retinitis Pigmentosa

    This leads to the development of colored spots in the fundus of the eye, which the doctor identifies by examining the fundus of the eye. It is one of the genetic diseases resulting from a defect in the genes.

    The onset of the disease occurs at the early stages of life, causing the child to suffer from poor vision during the night. However, as the years pass by and the child reaches the age of thirty, he, unfortunately, could lose the ability to see completely.

    Macular Degeneration

    It is one of the diseases associated with the macular hole in which the visual center in the retina is weakened, resulting in the emergence of some blind spots in the patient's field of vision. The patient does not lose the ability to see the peripheral side of the eye as it only affects the central vision.

    The main types of macular degeneration associated with aging are:

    Type 1: Dry macular degeneration

    This type occurs when the retina becomes very thin or because of the accumulation of waste in ​​the macula due to the separation of the retina from the vitreous body. If the patient fails to address this type early, the case can develop into the second type of macular degeneration.

    Type 2: Wet macular degeneration

    In this type, the retina loses the ability to perform its function because of a defect in the growth of blood vessels located at the bottom of the retina. This leads to abnormal bleeding of fluid and blood from these vessels. As a result of this bleeding, the eye may lose its central vision and only be able to see the peripheral or lateral vision.

    Treatment Of Retinal Problems

    There are several methods used to treat retinal diseases including the macular hole. The most important of which are:

    Retinal Laser Repair

    There are two types of lasers used in the treatment of retinal tears:

    Thermal Laser

    The doctor chooses this procedure before a complete detachment of the retina occurs. The procedure requires a hole in the pupil of the eye, and through this hole, the laser beam is directed to connect the retina with the underlying tissues.

    But it should be noted that this method results in some scars due to the burning beam that penetrates the pupil. Also, the patient can feel some pain that fades with time.

    Cold Laser

    This procedure does not leave scars or traces and helps treat retinal tears caused by diabetes, which results from the blockages of retinal blood vessels.

    Methods For Treating Retinal Detachment

    If you have a complete detachment of the retina, you will be glad to know that there are many procedures that doctors can use to treat your condition and prevent the macular hole, such as:

    Antenna Retinal Fixation

    The doctor injects an air bubble with a specific degree of gas concentration into the vitreous of the eye. He must be careful during this procedure so that the bubble expands within hours of its placement and pushes the retinal hole area to the eyewall to stop the Leakage of fluid behind the retina.

    This procedure requires the patient to follow a certain sitting position and head movement so that the bubble does not move until the retina takes its original place again beside the eyewall. The bubble disappears without any intervention and the fluid under the retina also disappears.

    Scleral Buckle

    The doctor uses this method to treat a retinal tear. He sews a piece of silicone with the white of the eye. If many tears are present in the retina, the doctor wraps a clip around the entire eye like a belt. The doctor performs this procedure without affecting vision, but the clip could stay in place for a lifetime.

    Vitrectomy

    The eye doctor treats a retinal tear by removing the gelatinous fluid. To do so, he injects silicon gas or any other suitable gas or liquid into the empty space. This procedure is suitable for patients who suffer from macular perforation, retinal tears, diabetic retinopathy, retinal detachment, or those who have been exposed to infection in the eye. The doctor can perform this procedure in conjunction with other procedures. The patient needs several months to recover completely.

    If a liquid or gas other than silicon is used, it gradually fades away with time without intervention. Silicon gas, however, requires surgical removal after a couple of months.

    Retinal Implant

    Doctors use artificial retinal implants as an alternative procedure to treat the vision center. This can be useful for patients who have no vision at all, but it is still uncommon among people.

    Eye Injection

    The doctor injects a type of medication into the space between the retina and the vitreous body, which is useful to treat diabetic retinopathy or wet macular hole.



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