Macular Hole & Macular Pucker

Retinal Degradation & Treatment

Macular Hole

The macula is the area of the retina that provides the best vision for reading and seeing fine detail. A hole in the macula can develop with age ("idiopathic" macular hole), trauma, and in people who are severely nearsighted. Idiopathic macular holes are common, usually occurring in patients over the age of 50. These holes form from pulling by the vitreous gel on the center of the retina. Macular hole formation occurs in stages beginning with a cyst (stage 1) and ending with a full thickness hole with separation of the vitreous gel (stage 4). Reading and detail vision is ultimately lost.

A vitrectomy may be used to remove the vitreous gel and close the macular hole. Fine membranes (scar tissue) are peeled from the edge of the hole and a gas bubble or oil bubble is placed in the eye to help seal the hole while it heals. When gas is used, the patient must remain face down for some time after surgery to help seal the hole. If oil is used, it must be removed in a second operation.

Macular Pucker

Scar tissue in the area of the retina that provides vision for fine detail and reading is called macular pucker or epiretinal membrane. Scar tissue can form in the center of the retina creating distortion and blurring. When the vision is only mildly affected, observation may be best. With significant distortion or blurring however, vitreous surgery can be used to restore vision for the majority of patients. Patients generally recover half of the vision lost from the macular pucker after surgery. Vision recovery can take weeks or many months, and as with all surgeries, the risks, benefits and alternatives must always be considered.

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