Macular Hole

Full thickness tear in central retina

Overview

A macular hole is a small full thickness defect in the center of the macula, the part of the retina responsible for sharp central vision. Most are idiopathic and occur in older adults, particularly women, as the aging vitreous gel pulls on the fovea before separating from it. Other causes include trauma and high myopia. Symptoms include blurred and distorted central vision and a small central blind spot, making reading difficult, while peripheral vision is unaffected. Macular holes are classified by size and by the stages described by Donald Gass, from an impending hole to a full thickness hole with complete vitreous separation, and OCT is used to confirm and measure them. Until the early 1990s they were considered untreatable. The surgery introduced by Kelly and Wendel, vitrectomy with gas tamponade, now often combined with peeling of the internal limiting membrane, closes a large majority of holes and is usually followed by a period of head positioning. The fellow eye carries some risk of developing a hole.