Macular Hole

"With current surgical techniques, we manage to close more than 90% of the macular holes".

DR. MANUEL SÁENZ DE VITERI VÁZQUEZ
SPECIALIST. OPHTHALMOLOGY DEPARTMENT

The macular hole is the presence of a small circular opening in the macula, which is the central area of the retina.

The retina is the layer at the back of the eye that captures light stimuli and perceives images that will be sent to our brain.

The central part of the retina is called the "macula" and is the area of the retina that allows us to see detail, read and see in color.

We have advanced technology for the diagnosis of the macular hole, such as wide-field fundus cameras and different models of OCT, including OCT angiography that allows, in a matter of seconds, to visualize with a maximum degree of detail, the different vascular plexuses of the retina, without the need to use contrast media.

Our team of retinal surgeons has extensive experience in the management of macular hole complications.

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What are the symptoms of macular hole?

Most of the time it causes blurred and often distorted vision (we would see straight lines or wavy or curved letters).

We may also appear to be missing a central vision patch.

The most common symptoms of macular hole are:

  • Significant decrease in visual acuity
  • Distorted vision (metamorphoses)
  • Dark areas of vision (scotomas)

Do you have any of these symptoms?

You may have a macular hole

What are the causes of the macular hole?

To answer this we would have to differentiate between two types of macular hole:

  • Idiopathic macular hole: also called senile because it mainly affects people over 60 years old and because it has to do with the aging changes that occur inside the eye. The vitreous gel becomes disorganized over the years and then contracts. The contraction of the vitreous gel can cause traction at a central level that ends up producing a macular hole.
  • Secondary macular hole: these can be due to the following causes: trauma to the eye, myopia, retinal detachment or cystic macular edema.

How is the macular hole diagnosed?

If the symptoms are compatible, it will be done:

  • A fundus examination under pupil dilation to check the condition of the macula.
  • An optical coherence tomography (OCT), since it is the diagnostic test of choice to confirm the diagnosis.

How is the macular hole treated?

If detected early, the treatment is highly effective.

The treatment of the macular hole is surgical. The surgery to be performed is called: vitrectomy, peeling and gas.

It is a type of microsurgery that is performed under a microscope, making 3 small incisions in the white part of the eye, through which very fine instruments are inserted.

First the vitreous gel is removed (vitrectomy), then a thin layer of retina (the internal limiting membrane) is gently peeled around the hole to relax the traction that it exerts on the hole and keep it open.

Finally, the eye is filled with gas that will plug the hole as it closes. As long as we have gas in the eye we will not see well, but it will gradually disappear over the next few weeks (2-8 weeks). Then we position the patient with the head upside down for 3-7 days so that the gas bubble compresses the macula and the hole closes.

If the macular hole takes less than 1 year, the surgery will manage to close this around 90% of the holes.

Of these, more than 70% will improve 2 or 3 more lines than before the surgery. But even if we do not achieve this degree of improvement, at least we will stop losing vision, which will stabilize and many patients will notice that the distortion decreases.

In a small percentage of patients the surgery does not manage to close the hole and the central vision will continue to deteriorate; however, if it does not close with the first surgery it can always be reoperated. It is important to understand that regaining completely normal vision is usually not possible.

Once a macular hole develops, the chance of it closing spontaneously is very small.

Without treatment, there is a small percentage of holes that can close spontaneously and improve vision. But in most cases, if left untreated, the central vision will gradually worsen, and may reach a level where they are unable to even read.

This pathology does not affect peripheral vision so patients will not go blind.

Where do we treat it?

IN NAVARRE AND MADRID

The Department of Ophthalmology
of the Clínica Universidad de Navarra

Equipped with the latest technology, the Department of Ophthalmology has the necessary equipment, both technical and human, to offer comprehensive and specific assistance to each patient.

We are one of the few centers that have a microsurgery laboratory for the improvement of clinical practice.

Organized in specialized units

  • Cornea and eye surface
  • Retina
  • General Ophthalmology
  • Refraction defects
  • Oculoplastic
  • Pediatric ophthalmology
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Why at the Clinica?

  • More than 25 years of experience.
  • Experts in the diagnosis and treatment of ocular pathologies.
  • With the security and guarantee of a prestigious hospital.