When it comes to retinal diseases, many people must have heard of a word: macular hole, but they are not very familiar with the relevant knowledge of macular hole. Today, Director Xu Zejun of Wuhan Purui Ophthalmology Hospital will explain in detail the relevant knowledge of macular hole!

1. What is a macular hole?

Macular hole, as the name suggests, refers to a hole in the macular region of the retina, mainly referring to a tissue defect that occurs from the inner limiting membrane to the photoreceptor cell layer in the macular region of the retina, seriously damaging the patient’s central vision. The incidence rate of this disease is not high, accounting for approximately 3.3 ‰ of the population. Among them, idiopathic macular hole of unknown cause is the most common (about 83%), often occurring in healthy women over 50 years old (average age of 65, female: male=2:1), with both eyes accounting for 6% to 28% of cases. Some also occur in younger patients. A complete loss of retinal tissue in the macular region is called a full-thickness macular hole, or a partial defect is called a lamellar macular hole.

Macular hole 404um

No macular hole

2. Why do we get macular hole?

In the aging process of the human body, due to the liquefaction of the vitreous body, there is varying degrees of posterior detachment between the posterior interface of the vitreous body and the surface of the retina, resulting in residual parts of the posterior cortex of the vitreous body on the surface of the retina. Due to the close combination of the two in the macular area, local vitreous macular traction causes the adhered retinal tissue to be torn off, forming a macular hole. The macular hole caused by age is called idiopathic macular hole.

Other common causes include trauma, high myopia, cystic macular edema, inflammation, retinal degenerative diseases, macular anterior membrane, and solar eclipse retinopathy.

3. What are the symptoms of macular hole?

Distorted and distorted appearance, black shadow in the center, and decreased vision are all symptoms of macular hole. As the disease progresses, vision will significantly decrease, visual distortion or even partial loss, accompanied by decreased color vision. If you have the above symptoms, seek medical attention promptly. You can use the following grid table to check for any changes on your own.

Be vigilant when the above situations occur

4. How to treat macular hole?

There is currently no specific medication for treating macular hole.

Most macular holes require surgical treatment, especially those that affect vision and cause visual distortion.

The main surgical method for macular hole is minimally invasive vitrectomy: first, the vitreous body around the macular hole is removed, and at the same time, the retinal inner limiting membrane around the hole is torn off to seal the hole. During the surgery, gas may be filled in the vitreous cavity to promote hole healing through the pressure of bubbles.

High myopia combined with macular hole: Surgery often uses silicone oil filling, and the time required for head down or prone position is longer.

Cataract combined with macular hole: requires combined phacoemulsification cataract surgery and appropriate intraocular lens implantation.

The postoperative visual acuity depends on the length of the disease and the size of the tear. Therefore, patients with macular hole need to undergo surgery as early as possible in order to achieve satisfactory treatment results. If the visual impairment is severe, performing surgery again will greatly increase the difficulty of postoperative recovery.

5. Will macular hole recur?

After surgical treatment, there is still a possibility of recurrence of macular hole, so patients need to undergo regular fundus examinations. If a proliferative membrane is formed again in front of the macular area of the retina and there is a possibility of recurrence of macular hole, further surgical treatment is necessary.

6. What should be noted after macular hole surgery?

1. After surgery, it is necessary to follow the doctor’s advice to use antibiotic eye drops to avoid postoperative infections, and regularly check the changes in the fundus;

2. Avoid vigorous exercise and hand rubbing of the surgical eyes;

3. If inert materials such as inert gas, silicone oil, etc. are used to fill the eyes during surgery, it is necessary to maintain a prone position after surgery, and one should not take a plane before gas absorption. When traveling to high-altitude areas, attention should also be paid to avoid gas expansion, which may cause an increase in intraocular pressure;

4. Postoperative patients should also pay attention to regular follow-up visits according to medical advice to avoid the recurrence of macular hole and further harm to their health.

This article is reprinted from "Dingxiangyuan"

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