Macular Hole

Retinal layer of the eye is the layer consisting nerves that realizes the coming light and sends it to the brain. If we consider the eye as similar to a photographic apparatus, retinal layer would be the film strip inside it. Macular region is located right on the middle of this layer, and in the very middle of this region, fovea region is located. Fovea region is in the size of a pinhead. Fovea region, or colloquialy, “yellow spot”, is the most important region responsible of the central and detailed vision of the retinal layer.
Macular hole is the perforation emerging right in the middle of the visual center. Patients having macular hole have a black spot on the visual center and this affects vision. Detailed vision functions are specifically affected such as spotting the faces of individuals, reading newspaper and so on. Central vision is not affected because the other retinal regions are normal.         
Typical macular hole                                              Macular hole in optical coherence tomography

The factors leading the macular hole are not exactly known, however a group of changes due to aging take part in this. Intraocular fluid called vitreus wrinkles in time and it applies a force of shrinkage and creates a hole in this region.
The most common reason of macular hole is called idiopathic. This situation emerges without a cause or reason. Aging has an effect. Besides that ophthalmic traumas may cause macular hole. If the macular hole emerges by itself, the possibility of its emergence in the other eye is higher than those who do not possess.
It is not possible to treat macular hole with medicine; vitrectomy surgery is performed. In vitrectomy surgery vitreus fluid is cleared, thin membranes, located in macular region and causing shrinkages are peeled, and then a gas like air is injected to intraocular. After the surgery, because of this gas in intraocular, the vision will be low for a few weeks. When the gas is shrinked by the eye and as the intraocular fluid takes its place the patient’s vision will recover. The success rate of the surgery, meaning the possibility of the closing of macular hole is around 89 – 90%. However in traumatic cases, in long lasting macular holes, in wide scaled holes this success rate decreases.
Macular hole surgery could be performed with local or general anesthesia. To increase the chance of the closing of macular hole, patients should rest in the face down position for a few days.

After the macular hole surgery the patient should lie in the face down position