Explanation - Idiopathic macular hole is a condition whereby a "stretch" hole is created in the center of the macula causing decreased vision and distortion. Patients usually complain of progress loss of central vision with difficulty reading and seeing a person's face. The symptoms usually progress over a period of 2-3 months or more. It does not cause blindness. The paracentral vision is preserved as is the peripheral vision. Macular holes are repaired with vitrectomy surgery involving the injection of intraocular gas into the eye.

The cause of macular holes is thought to be due to an epiretinal membrane causing the macula to stretch, thereby causing a hole. A favorite example would be holding a piece of balloon and shoving a pin through the balloon material. If you were to stretch the balloon in all directions, a round hole would develop where the pin perforated the balloon. This is how macular holes develop. The macular tissue develops a hole as forces stretch the macula outward.

Surgery is usually indicated to repair macular holes. Surgery involves a vitrectomy, removal of the epiretinal tissue and/or internal limiting membrane and gas injection. Face down positioning is required for up to a week. Many surgeons use a different gas and require a longer, 3 week, face down position.

Results vary, but in most cases the hole closes with one operation. Occasionally a second operation is helpful if success was not achieved the first time. The goal of the surgery is to improve vision and close the macular hole. It is unlikely that there will be complete restoration of vision despite successful vitreo-retinal surgery.

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