What is a Macular Hole?

Macular hole is when a tear or opening forms in the macula. As the hole forms, things in central vision will look blurry, wavy, or distorted.

The macular hole can be bilateral, but it is generally asymmetric (it appears in one eye before the other).
The macular hole can present different stages, until reaching a complete retinal thickness.

What Causes a Macular Hole?

There is a relationship between aging and the onset of a macular hole, since they generally occur in people over 60 years of age.
As you age, the vitreous humor (a clear gel that fills the eye) begins to shrink and pull away from the retina (vitreous detachment). In the vast majority of people, the vitreous detaches without causing any problem, beyond the “floaters”. However, the vitreous can stick to the retina in some areas. When this happens, it pulls (pulls on) the macula, which produces a stretch of the retina at that level and the subsequent rupture of the retina.
Other causes of a macular hole are trauma, previous retinal detachment surgeries, or high myopia (very high).

Is it possible to prevent Macular Hole onset?

Unfortunately, to this day, there is no method to prevent the onset of a macular hole. The most important thing is to make a diagnosis in early stages of the disease; therefore, periodic ophthalmological examinations are very important. Special attention must be paid to those patients who have had a macular hole in the contralateral eye.

Symptoms

Patients with a macular hole present with symptoms known as “macular syndrome”, characterized by: metamorphopsia (distorted vision of objects), decreased visual acuity (remember that the macula is the area responsible for high-quality vision), macropsia or micropsia (seeing objects larger or smaller than they actually are), and the presence of a scotoma (area without vision) relative (it looks bad, but something can be seen) or total (nothing can be seen).

Diagnosis

A full ophthalmological examination, paying special attention to the examination of the retina, may be sufficient to diagnose the more advanced stages.

One of the most useful tools for diagnosing a macular hole is the optical coherence tomography (OCT). OCT is a non-invasive technique that allows the study of the different layers of the retina. The OCT performs multiple scans of the retina, allowing detailed analysis of the macular area.

Treatment

Vitreous surgery (vitrectomy) is the best way to treat a macular hole. Its implantation in the treatment of the macular hole has managed to improve the visual prognosis of these patients. The most commonly used technique includes the extraction of the posterior hyaloids and the epiretinal membranes of the macular area, with the use of gas tamponade for a long time. This gas bubble helps flatten the macular hole and hold it in place while the retina heals. The gas bubble slowly disappears on its own and is replaced by fluid naturally produced by the eye.

A new therapy has recently appeared, which aims to reduce and improve the tissue repair and healing process, such as PRGF®-Endoret®, a concentrate of growth factors and other proteins obtained from the patient’s own plasma. The administration of plasma rich in Endoret® growth factors (PRGF®) stimulates the regeneration of tissues (in this case the retina), increasing the presence of growth factors and other proteins in the tissues.

Endoret® system (plasma rich in growth factors) preparation is relatively simple, it is very easy to activate it, and its administration is very simple. Once inside the eye, Endoret® forms a fibrin mesh over the macula, releasing these trophic factors and facilitating the closure of the macular hole.
The use of this combined technique [vitrectomy + Endoret® (PRGF®)] is especially indicated for the treatment of macular holes in large myopic patients, whose prognosis is much higher than that of idiopathic macular holes (without known cause). With this treatment, the prognosis of macular holes associated with high myopia has improved considerably.

Prognosis

 

The introduction of vitrectomy has significantly improved the prognosis of the macular hole, especially in early cases or small-sized macular holes. In the most incipient cases, very good results are achieved, both anatomical (closure of the hole) and functional (visual recovery). Additionally, the introduction of the Endoret® System has led to an important improvement in the prognosis of the most complicated cases, especially in myopic macular holes.