The back of the eye consists of a rather dense, gel-like material called vitreous humor (or even vitreous or vitreous body) which helps the eye maintain its shape. With aging, the vitreous shrinks naturally and becomes more and more fluid.
Since the vitreous is attached to the retina through tiny filaments of cells, its shrinking can pull it and, in the most serious cases, causes the tearing of a small piece of the retina, giving rise to a hole. If this missing piece of the retina is found in the macula (the central area of the retina of the human eye, the most sensitive to light stimuli), an ocular pathology is presented, called macular hole.
The eyesight of those suffering from macular holes becomes blurred and distorted and, in the most serious cases, the visual ability is seriously compromised.
If left untreated, a macular hole can worsen over time, evolving from one stage to another. The macular holes are in fact in three phases:
- Foveal detachments: about 50% worsens without treatment.
- Partial-thickness holes in the foveolar area: about 70% worsens without treatment
- Full-thickness holes in the foveolar area: most of them get worse without treatment.
A macular hole can sometimes be resolved without intervention but most need to be treated to prevent permanent loss of vision.
Macular Hole Surgery and Treatment
Vitrectomy is the most common treatment for macular holes. In this surgery, the doctor surgically removes the vitreous gel to prevent it from pulling on the retina; then inserts a mixture of air and gas into the space occupied by the vitreous, generating a bubble of air and gas that keeps the edges of the macular hole under pressure, allowing it to heal. The patient must remain to lie in a flat position so that the bubble remains in the correct eye position, sometimes for two or three weeks.
Although it can be inconvenient and tedious to remain still for such a long time, this approach is necessary to achieve recovery of vision. The gas/air bubble gradually disappears over time and the natural eye fluids return to their place as the hole closes. If the patient has undergone surgery for a macular hole using a gas bubble, he will not be able to travel by air for several months, because the gas can expand due to pressure changes, causing further damage to the eyes.
The risks of vitreous surgery include infection and detachment of the retina. Both of which are curable disorders. The most common risk, however, is the development of cataracts. Cataracts typically occur rather quickly after a vitrectomy but can be removed once the eye has healed.
People who have found a macular hole in one eye are more likely (about 10%) to develop a macular hole in the other eye at any point in their lives. Therefore, it is necessary to undergo regular eye exams to identify the onset of the problem in advance.