Macular Hole

What is Macular Hole?

A macular hole is a small break in the macula — the central, most sensitive part of the retina. It typically forms when the vitreous gel pulls on the macula as it separates from the retina (posterior vitreous detachment). Most macular holes are idiopathic, occurring in people over 60, and are more common in women. Left untreated, the hole tends to enlarge and vision deteriorates progressively. Surgery to close the hole achieves good results in the majority of patients.

Symptoms

• A blurred or missing spot in the centre of vision
• Distorted central vision — straight lines appearing wavy
• Difficulty reading fine print
• Reduced visual acuity, particularly for detailed tasks

Causes

• Vitreous traction during posterior vitreous detachment (most common)
• High myopia (severe short-sightedness)
• Blunt eye trauma
• Epiretinal membrane contraction

Diagnosis

Optical coherence tomography (OCT) is diagnostic — it confirms the presence and stage of the hole, measures its size, and guides surgical planning. Visual acuity and Amsler grid assessment are also performed.

Treatment

Small macular holes may occasionally close spontaneously, particularly in myopic patients. For full-thickness macular holes, vitrectomy surgery with internal limiting membrane (ILM) peeling and gas tamponade achieves closure rates of over 90%. Posturing (face-down positioning) for 5–10 days after surgery improves outcomes.