Are related to aging and usually occur in people

over age 60

Idoipathic Macular Holes

With age, the vitreous shrinks and shifts toward the front of the eye, pulling away from the surface of the retina.

Macular Holes

For few people, the attachment of the vitreous to the retina may be strong enough that the pull of the contracting vitreous can create a hole in the central retina, known as a macular hole.

The replacement fluid may seep through the hole, lifting the retina and causing distortion in central vision.

Gender

F /M = 3/1

Bilateral

10-20% of patients if no PVD2% if there is PVD

Clinical Spectrum Ranges from;

Stage I Foveal detachmentStage II Partial thickness holeStage III Full thickness hole without posterior vitreous detachment.

Stage IV Full thickness hole with complete posterior vitreous detachment .

Vision Vision mar range from 20/20 to <20/400

Causes1 )Idiopathic

2 )Other causes such as: High Myopia

Chronic Macular Edema and Trauma

Complications

RD<5% of cases

Investigations1 .Slit lamp

2 .OCT

RX and follow upStage 1: observation and 6 monthly follow up

Stage 2, 3 & 4: vitreous surgery with ILM peeling and gas

( C3 F8 )tamponade.

Macular HolesMacular holes were once considered an untreatable problem, however, because of advances in retinal surgery, many

patients can be helped .

AgeIt is possible for anyone to develop a macular hole, but it is most common among women about 60-70 years of age.

Patient's recovery depends on:

1 .The severity of the hole2 .Time since onset

3 .Sometimes the hole spontaneously resolves .

The Biggest ChallengeOf macular hole repair is to maintain the proper head position after operation for approximetry two weeks following the surgery.

Silicon Oil

The eye can be filled with silicon oil instead of gas. This is easier for the patients because no special positioning is necessary, however, the oil must be removed with a second

operation several months later .

ResultsWe are able to restore partial visions in 70-90% of patients,

usually two lines or better .

Diagnosis The diagnosis of macular holes in the easy stages may be challenging or difficult especially when there are concomitant disorders of the macular, such as age related macular degeneration.

The ophthalmologist must rely on both the patient's vision and the subtlest signs of the disorder, which may include a faint yellow spot or ring in macula. Flurescine

angiography may be helpful .

Risk for the other eyeA macular hole in the opposite

eye is about 10% .

Indication for Macular Hole Surgery

1 .Presence of macular hole confirmed by examination.

2 .Reduction of vision due to macular hole .

Risks of Macular Hole Surgery

Include :1:Bleeding2:Infection

3:Retinal detachment4:Glaucoma

5:Progression of cataract

It is advisable not to travel in an airplane while air remains in the vitreous.

Are macular holes related to macular degeneration?

Macular holes and macular degeneration are not related. A macular hole is caused by the vitreous pulling on the front of the retina while macular degeneration is caused by changes to tissue behind the

retina .