Macular cyst, retinal hole, retinal tear, and retinal perforation.

The macula is a tiny oval area made up of millions of nerve cells located at the center of the retina. The retina is the light-sensitive tissue at the back of the eye. The macula is responsible for sharp, central vision. A macular hole is just that: a hole in the macula.

The eye contains a jelly-like substance called the vitreous. Shrinking of the vitreous usually causes the hole. As a person ages, the vitreous becomes thicker and stringier and begins to pull away from the retina. If the vitreous is firmly attached to the retina when it pulls away, a hole can result.

The size of the hole and its location on the retina determine how much it will affect vision. Generally, people notice a slight distortion or reduction in their eyesight. However, if the hole goes all the way through the macula, you can lose a lot of your central and detailed vision.

No, they are two different diseases even though they have similar symptoms. An eye care professional will know the difference.

A surgical procedure called vitrectomy is often used to treat holes that go all the way through the macula. The vitreous is removed to prevent it from pulling on the retina. It is replaced with a gas bubble that eventually fills with natural fluids.

Following surgery, patients must usually keep their faces down for two or three weeks. This position allows the bubble to press against the macula and seal the hole.

Vitrectomy can lead to complications, most commonly an increase in how fast cataracts develop. Other less common complications include infection and retinal detachment either during surgery or afterward.

The surgery is about 90 percent effective in closing the hole. However, improvement in people's vision is more variable. More than half of those who have the surgery can expect an improvement of two lines or more on the vision chart.

Very few people get a macular hole in the second eye. Your eye care professional will be able to talk to you about your risk.

Research studies are being conducted to determine other treatments for macular holes. Currently the research is looking at using silicon oil to close the macular hole instead of the gas bubble that is being used now. No definite conclusions have been reached at this time.

The following organization may be able to provide additional information on macular holes:

American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94120-7424
(415) 561-8500
Distributes a fact sheet on macular hole for patients.

For additional information, you may also wish to contact a local library.

Below is a sample of the citations available in MEDLINE, a comprehensive medical literature database coordinated by the National Library of Medicine (NLM). MEDLINE contains information on medical journal articles published from 1966 to the present. You can conduct your own free literature search by accessing MEDLINE through the Internet at http://medlineplus.nlm.nih.gov. You can also get assistance with a literature search at a local library.

To obtain copies of any of the articles listed below, contact a local community, university, or medical library. If the library you visit does not have a copy of a particular article, you may usually obtain it through an inter-library loan.

Please keep in mind that articles in the medical literature are usually written in technical language. We encourage you to share any articles you order with a health care professional who can help you understand them.

Surgical management of macular holes: a report by the American Academy of Ophthalmology. Benson WE, Cruickshanks KC, Fong DS, Williams GA, Bloome MA, Frambach DA, Kreiger AE, Murphy RP. Ophthalmology 2001; 108(7):1328-1335
This document describes macular hole surgery and examines the available evidence to address questions about the effectiveness of the procedure for different stages of macular hole, complications during and after surgery, and modifications to the technique. The evidence does not support surgery for patients with stage 1 holes. Properly conducted, well-designed randomized trials support surgery for stage 2 holes to prevent progression to later stages of the disease and further visual loss. Additional evidence shows that surgery improves the vision in a majority of patients with stage 3 and stage 4 holes. There is no strong evidence that adding another form of therapy at the time of surgery results in improved surgical outcomes. Patient inconvenience, patient preference, and quality of life issues have not been studied.

Macular hole surgery in 2000. Margherio AR. Michigan State University College of Human Medicine, Grand Rapids, MI. Current Opinion in Ophthalmology 2000; 11(3):186-90.
This article begins by describing possible causes of macular holes. It then discusses the different stages of macular holes, the surgeries being used to close the holes, and different procedures that combined with surgery can get the best possible results.

Complications of macular hole surgery. Javid CG; Lou PL. Massachusetts Eye and Ear Infirmary, Boston, MA. International Ophthalmology Clinics 2000; 40(1):225-32.
This article begins with a brief overview of macular holes. The article discusses why macular holes form, conditions that can be mistaken for macular holes, and the different stages of macular holes. The article continues on to describe how a vitrectomy is done and talks about the different complications that can follow vitrectomy. Six possible complications are discussed in detail. Possible reasons for complications are mentioned, as well as how common each complication is.

Macular hole. University of Pennsylvania Scheie Eye Institute, Retina Service, Philadelphia, PA. Survey of Ophthalmology 1998; 42(5):393-416.
This article reports on different theories that have been proposed over the years to explain the development of macular holes and then describes the current theory. The different stages of macular holes are explained, along with different diagnostic tests for detecting them. The article then lists various diseases that can be confused with a macular hole and details how macular holes progress. Risk factors for developing a hole in the unaffected eye are also noted. The article ends with a discussion of the success of different treatments used to manage macular holes and describes the complications that can result from these treatments.

The National Eye Institute (NEI), part of the National Institutes of Health (NIH), is the Federal government's principal agency for conducting and supporting vision research. Inclusion of an item in this Information Resource Guide does not imply the endorsement of the NEI or the NIH.