The macula is the part of the retina responsible for fine central vision necessary for reading, watching television, and recognizing faces. A macular hole is a small round opening in the macula which causes a blind spot or blurred area in the central vision.
Most macular holes occur due to age. When the vitreous (the gel-like substance inside the eye) ages and contracts, it can pull on the thin tissue of the macula causing a hole to develop. Sometimes, trauma or chronic swelling can also result in a macular hole. No specific medical problem is known to cause macular holes.
Vitrectomy surgery, the only treatment for a macular hole, removes the gel and scar tissue pulling on the macula which keeps the hole open. The eye is then filled with a gas bubble to help close the hole. The gas bubble will gradually dissolve over the course of 3-5 weeks. Usually, the patient is instructed to remain in a face down position for 5-10 days to keep the gas bubble in contact with the macula while the hole closes. Patients should avoid lying flat on their backs, flying, and certain types of general anesthesia while the gas bubble is in the eye.
With surgery, the majority of macular holes close resulting in improved vision. The degree of improvement often depends on the size of the hole and the length of time the hole was present. Generally, vision does not return completely to normal even with successful repair.