Full Thickness Macular Hole and Treatment

Understanding Macular Holes: The macula is the central part of the retina and the area responsible for detailed vision. A full thickness macular hole is a split in the very centre of the macula. Patients with a full thickness macular hole typically experience distorted central vision, with difficulty reading and recognizing faces. Their peripheral vision remains intact. Macular holes most commonly occur in females over 60 years of age. Measurements of the size of a macular hole along with other characteristics evident on an OCT scan provide vital case specific information on the most appropriate treatment and likely outcome.

Natural History: Macular holes vary gSome small macular holes close spontaneously.  Some will also close with eyedrops, although the most suitable cases and long term success rate of such medical therapy is  currently unknown.   Most macular holes however gradually enlarge over months to years, causing progressive central vision loss.  Larger holes have a lower surgical success rate.  The fellow eye carries approximately a 10-15% risk of developing a macular hole.

Surgical Treatment: In general early treatment is better than a delay. Surgery for symptomatic full thickness macular holes should achieve closure rates of more than 90%.  The surgical approach to a macular hole has become much more case specific over the last decade and, despite already very high success rates, continues to evolve.  A vitrectomy with a gas bubble is standard to nearly all approaches.  Different gas bubbles can be used with some taking less time to absorb than others.  Depending on the hole size various different bespoke adjunctive measures are applied, including peeling membranes, creation of ILM flaps and use of patches in some larger holes. 

Postoperative Positioning: Rigorous face-down positioning has traditionally been recommended following macular hole surgery.  There is now a much better understanding of the definite but limited gain from rigorous face down positioning.  The relative merits of face down versus less rigorous post op positioning can be discussed on a case by case basis.  

Combined Cataract and Macular Hole Surgery. Most people over 50 years of age who undergo a vitrectomy will develop a cataract needing surgery within 2 years.  As a result it has become standard practice for some surgeons including Mr Laidlaw, to discuss performing cataract surgery at the same time as the macular hole surgery.

Redo Surgery Whilst most first macular hole operations succeed in closing the hole some do not.  Redo surgery is a recognised and worthwhile procedure, sometimes involving different adjunctive techniques.    

Visual Outcome Successful macular hole surgery usually greatly improves the vision of the affected eye and prevents further deterioration.  The central vision does not however go back to normal, patients usually remain aware of a small central gap in their vision along with some but less distortion.   

 Mr Laidlaw is highly experienced in all aspects of macular hole surgery and has been involved in several of the research studies which guide our current clinical approach.