Macular Hole

DEFINITION: This hole develops in the center of the macula which enables the central vision. It has four phases. It mostly emerges by the detachment of the vitreus from the macula due to aging. It occurs in 3 cases out of 1000. Once one of the eyes is affected, the risk of development in the other eye within 5 years is 10%.

Figure 1. Preoperative (left) and postoperative (right) Multicolor optical coherence tomography images of a patient operated for full thickness macular hole at our hospital.

RISK FACTORS: It mostly affects individuals who have no eye diseases and who are over 50 years of age. It is more common in women. It may also develop due to high myopia, trauma, intraocular inflammation, retinal detachment and other eye diseases.

FINDINGS: The disease starts with distorted and blurred vision in the center of vision. With the expansion of the hole over weeks and months, central vision is seriously affected.

Figure 2. Preoperative (left) and postoperative (right) B scan optical coherence tomography images of the same patient mentioned above.

DIAGNOSTIC TESTS: It can be detected in the retinal examination carried out after the pupil is enlarged with the help of drops. Patients report the center of the light directed at the eye during examination to be thin or completely deleted (watzke-allen test). Shininess at the bottom of the hole can be detected via retinal angiography. Size of the lesion, phase of the hole, and whether it is a complete layer can clearly be determined via retinal tomography (OCT).

TREATMENT: Vitrectomy surgery is applied for treatment. The internal limiting membrane in the macular area is stripped and gas tamponade is applied to close the hole. In order for surgery to be successful, the patient must rest facedown for 4-7 days following the surgery. Although the success of the surgery depends on the phase of the disease, closing of the hole and increase in vision are achieved at high rates.