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Macular Holes

What is a macular hole?

The macula is the central and most delicate portion of the retina. In some individuals, a cellophane-like film may build up on the surface of the macula (called an epiretinal membrane). For reasons not completely understood, this film and the vitreous gel that normally fills your eye, may slowly distort and stretch the underlying tissue causing a hole to form in the macula. A macular hole is tiny—usually a fraction of a millimeter—but can result in severe blurring, distortion, and loss of detail vision.

There is no accepted therapy for preventing a macular hole from forming. Early macular holes—where some stretching is seen but no actual hole has developed—may in some cases spontaneously improve. Once a true hole has developed, however, vision is markedly blurred and rarely improves spontaneously. Up until 10 - 15 years ago, no treatment was available, and the visual loss from macular holes was permanent.

How are macular holes repaired?

Currently, the most effective treatment for macular holes is surgery. The procedure, called a vitrectomy, involves inserting tiny instruments into the anesthetized eye to remove the vitreous gel, allowing access to the macula. Delicate forceps are then used to peel away the epiretinal membrane, which allows the macula hole to close.

Why must I position my head down after surgery?

The most important part of the surgery occurs after the procedure is done. At the end of surgery, the eye is filled with a special gas that gently pushes against the macula to keep the hole closed while the eye heals. As bubbles rise to the surface of water, the gas bubble floats to the top of the liquid that normally fills our eyes. Since the macula is in the back of the eye, in order for the gas to properly support the macula, the patient must maintain a face-down position 18-22 hours per day after surgery or the likelihood of success will be dramatically reduced.

Staying face down virtually all day can be unpleasant and there are special chairs designed for massages to rent, which support the body and head in a face down position. Alternatively, a pillow can be placed on the surface of any table, and the forehead placed on the pillow for support. While in bed, the face should be against the pillow, but can be turned slightly toward one side to assure easy breathing. The most important thing is to maintain face down position all the time! During meals or trips to the bathroom, steadily looking downward will help keep the gas bubble in contact with the macula. We strongly discourage patients from simply sitting face down with out any support for the neck, as neck strain will set in quickly and will make any further positioning uncomfortable.

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