A macular hole is an ocular condition characterized by the formation of a full-thickness, generally round-shaped defect in the macula, the central area of the retina responsible for central vision. In its early stages, symptoms include blurred, wavy, or distorted central vision. As the condition progresses, a dark spot or blind area may appear in the central vision, while peripheral vision generally remains unaffected.
The most common form is idiopathic macular holes, whose pathogenesis appears to be related to tractional forces exerted on the macula by the vitreous and the internal limiting membrane. However, several conditions may increase the risk of developing this pathology: ocular trauma, high myopia, and retinal detachment.
Although the macular hole is usually unilateral, in some cases it can affect both eyes, making regular ophthalmological monitoring crucial in at-risk individuals.
Early diagnosis and prompt treatment are essential to achieving the best visual outcomes. The appearance of symptoms such as visual distortion or central vision loss requires immediate ophthalmologic evaluation to preserve visual function.
The most effective treatment for macular holes is vitrectomy, a surgical procedure in which the vitreous body is removed, and the internal limiting membrane is peeled to relieve the traction on the macula. After removing the vitreous, a gas bubble is inserted into the eye, which exerts gentle pressure against the retina, promoting the closure of the hole and allowing healing. The gas bubble is gradually reabsorbed over the following weeks. After surgery, it is often necessary to maintain a face-down position for a period of 4 to 7 days to optimize the contact between the gas bubble and the macula.