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Macular Holes

What Is a Macular Hole?

Sometimes, a small break may occur in the retina. This is known as a macular hole. Usually a macular hole occurs in patients over 60. When this occurs, patients can notice blurred or distorted central vision.

Stages of a Macular Hole

  • Foveal detachments (Stage I). Without treatment, about half of Stage I macular holes will progress.
  • Partial-thickness holes (Stage II). Without treatment, about 70 percent of Stage II macular holes will progress.
  • Full-thickness holes (Stage III). Usually the size of the hole and its location determine the amount of vision loss. If left untreated, a macular hole could lead to a retinal detachment, which can cause full and permanent blindness.

How Is a Macular Hole Treated?

Sometimes, no surgery is necessary, as macular holes can seal themselves. But surgery is often necessary to improve vision and to prevent further damage. Usually a vitrectomy is performed to remove the vitreous gel to prevent it from pulling on the retina. This vitreous is replaced with a bubble containing gas that acts as a temporary bandage to hold the macular hole in place as it heals.

Surgery is usually performed under local anesthesia on an outpatient basis. After surgery, patients must remain in a facedown position for one to two days. More difficult cases may require three weeks spent resting in such a position. This allows the air bubble to press against the macular hole as it heals. Although uncomfortable, this is a crucial step to the success of the surgery.

What Is a Macular Pucker?

A macular pucker, also commonly known as an epiretinal membrane, is scar tissue that develops around the macula. A macular pucker often causes blurred and distorted central vision. A macular pucker is also known as cellophane maculopathy, retina wrinkle, surface wrinkling retinopathy, epiretinal membrane, preretinal membrane, internal limiting membrane disease, and premacular fibrosis.

What Are the Symptoms of a Macular Pucker?

Symptoms can greatly vary from no loss to severe loss of vision. Some patients may start to notice lines appearing wavy or their vision becoming blurry. Some patients may also notice difficulty seeing fine detail when reading, or even a blind spot.

How Is a Macular Pucker Treated?

In most cases, a macular pucker doesn’t require treatment. In many cases the symptoms of blurriness or distortion are mild. Most patients can adjust to mild visual distortion, even while reading or driving a car. In some rare cases, the vision can decline to the point that daily activity becomes impossible. When this happens, surgeons will typically perform a vitrectomy. After the surgery, the patient will wear an eye patch for a few days and will also use medical eye drops for up to a few weeks to guard against infection.


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