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A macular hole is a general term for a break or defect in the macula, which is the part of the central retina responsible for our most detailed vision. There are different types of macular holes including partial thickness and full thickness macular holes as well as lamellar holes and pseudoholes.

Macular Hole

The vitreous is the gel that fills the back portion of the eye. At a young age that gel is attached to the macula. With aging, the gel eventually undergoes a process when it separates from the macula without disruption to the architecture of the retina. In some patients the gel is particularly sticky and as the gel separates instead of disconnecting easily it instead pulls on the macula and can pull the retina apart creating a hole. This is the most common cause of partial thickness and full thickness macular holes.

A less common cause of macular holes is trauma. Some patients can develop macular holes associated with retinal detachments as well. Lamellar macular holes and pseudoholes occur due to pulling/tension from epiretinal membranes (see Epiretinal Membrane).

The symptoms of a macular hole are distorted vision as well as blurred vision. If patients look at a straight line they may notice the lines are distorted or bent. Some patients with partial thickness and full thickness macular holes will also describe a small blind spot in their vision.

Typically our specialists only see macular holes in patients over the age of 60, more commonly men than women. As age is the primary risk factor for this condition, other times we see the diagnosis in conjunction with a patients’ history of retinal tears and/or detachments, macular pucker, diabetic eye disease (diabetic retinopathy), preexisting trauma to the eye, retinal vein occlusions or uveitis.


Treatment options include an intravitreal injection of a drug called ocriplasmin (Jetrea™), an in-office pneumatic vitreolysis, and surgical repair in the operating room with a pars plana vitrectomy. The first two procedures can only be performed when the gel is still actively pulling on the macula. Jetrea is a medicine that is injected into the eye that can break the connection between the gel and the retina. If that connection breaks, sometimes the hole will close on its own once the traction is relieved. Pneumatic vitreolysis is when a gas bubble is injected into the eye in clinic then when the patient bends forward over and over the bubble rolls across the back of the eye attempting to break the connection between the gel and the retina, sometimes allowing the hole to close once that connection is broken. Pars plana vitrectomy is the most successful way of closing the hole but requires going to the operating room for surgery. Surgically the gel is removed from the eye, a layer called the internal limiting membrane of the retina is removed, and then the eye is filled with a gas bubble. That gas bubble helps push the hole closed. Gas bubbles dissolve away on their own over a period of 3 to 8 weeks. Sometimes your surgeon will ask you to maintain a face-down position to maximize the changes of surgical success.

Macular Hole Diasnosis

© 2019 American Academy of Ophthalmology

According to the American Society of Retina Specialists (reference) Optical coherence tomography (OCT) is the current gold standard in the diagnosis and staging of macular holes. This quick, non-invasive imaging technique allows for evaluation of the macula in high resolution using reflected light, and helps your doctor differentiate a hole from other eye conditions with similar symptoms. No laboratory tests are needed in cases of idiopathic macular holes (those without a known cause).



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