lasik-logo Treatment for Macular Hole




Treatment/prognosis of a Macular Hole

 It is very important to determine what stage the macular hole is in order to intervene with proper treatment when necessary.  A thorough microscopic exam of the macula is necessary though it is sometimes difficult to determine the stage without special equipment.  There are two special tests that are typically used for diagnosis.  The first technique is a fluorescein angiography (IVFA) which is the old standard of care.  An IVFA is a test which requires dye be injected into a vein in the arm and as the dye passes through the retinal blood vessels pictures are taken with UV light.  The problem with this test is that some people are sensitive to this dye and the injection could be fatal for them.  The second diagnostic test which is becoming much more popular is called optical coherence tomography (OCT).  The OCT takes a quick cross sectional picture of the retina by a technique known as interferometry.  Light beams are directed into the eye at certain angles and the amount of interference is measured creating a very detailed image of the entire depth of the retina.  The new OCT machines are spectral domain.  They give a much more detailed image (5-10 microns) than the older time domain OCT machines.  The advantage to an OCT picture is that it is much less invasive, completely safe and much faster than a fluorescein angiography.  It takes a couple seconds to get an image just like taking a picture with a regular camera. 

There is also something known as a pseudohole which is caused by the traction of an epiretinal membrane giving the appearance of an impending hole.  A regular biomicroscope may make the differentiation difficult but special testing with an OCT will give an obvious diagnosis. 

Below is an OCT image of a normal macula taken with the iVue OCT machine

OCT of normal macula retina scan at eye doctor austin 

This is an OCT image taken with the RTVue OCT which shows vitreomacular traction.  You can see the impending vitreal detachment labeled as “EVOLVING PVD.”  The arrow to the left shows the vitreous pulling at the macula. 

OCT scan of PVD Vitreo retinal traction resized 600 

 

 

This RTVue OCT image shows a full thickness macular hole.  You can see that the tissue below the macula is completely missing. 

Macular hole retina scan OCT Master Eye Doctors 

 

A vitrectomy (surgery to remove the vitreous) is a possible treatment in order to stabilize the condition.  If done in stage 1 it has been shown to prevent the progression to a full thickness hole.  If done in stage 2 there may not be an improvement in visual acuity but there is stability of visual acuity.  Visual success is also much better in acute holes versus longstanding holes.  If there is an epiretinal membrane present then success is contingent upon removal of the membrane during surgery. 

The treatment for a macular hole is determined on a case by case basis.  The risks and benefits must always be weighed.  The other eye should be considered and whether it is likely or not likely at all to also develop a macular hole.  The length of time the hole has been present must be considered as well as any associated epiretinal membranes.  The cause of the macular hole must also be looked at.  If it was caused by trauma and there is surrounding damage then the procedure may not be beneficial.