Macular hole is an abnormal defect in the central part of the retina. Unlike retinal tears that occur in the peripheral retina, macular holes are usually not precursors to retinal detachment. A macular hole looks like a round punched-out defect. Because of its location, this type of retinal hole can cause severe central vision loss. The normal retinal tissue that should fill the hole is usually not missing, though; it is merely spread out to the edge of the hole. Surgery can close the hole, and allow that tissue to return to a normal position, improving vision.
Imagine pushing a pencil through a screen; the wires making up the screen are pushed aside, not punched out. The wires may be pushed back into their normal position to repair the screen. Although trauma or disease can cause macular holes, they are usually seen as an age-related manifestation of an abnormality of the vitreous-retinal interface. For unknown reasons, they occur more frequently in women than in men.
Surgery is necessary for the treatment of most macular holes. Macular hole surgery consists of a vitrectomy (removal of the vitreous gel) and filling of the vitreous cavity with a mixture of air and gas. The patient is then asked to remain in a face-down position for 1-2 weeks following this surgery, to allow maximum air/gas contact with the macula. Usually, the intravitreal air/gas spontaneously absorbs from the eye within 6-8 weeks following the operation. In most cases, a macular hole can be closed in this fashion with at least partial restoration of central vision.