Macular Hole

A macular hole is a small defect in the macula, the center of the vision that is responsible for fine, detailed vision.  It is most common in women and in patients over the age of sixty, but can present in people of all ages.  Macular holes are caused by pulling of the vitreous on the center of the vision.  The vitreous can physically pull a hole in the macula or can lead to tension on the macula that creates a hole.

When patients develop a macular hole, they will often notice blurred vision in the eye or a missing area of their vision.  Sometimes, however, patients do not notice the symptoms of the macular hole and are instead discovered on routine eye exams.

There are different stages of macular holes. Stage 1 macular holes have a 50% chance of resolving without any intervention. Stage 2, 3, and 4 macular holes require treatment for resolution.

There are 2 treatment options available to fix a macular hole.  The first is an injection of a medication called ocriplasmin into the eye.  This medication can dissolve the adhesion of the vitreous from the hole and lead to closure.  It only works in some macular holes that have specific criteria, so it is not an option for all patients.  The second option for macular hole repair is surgery.  The surgery is a vitrectomy, or removal of the vitreous fluid from the eye, followed by an ILM peel and gas placement.  The ILM is a very thin sheet of tissue that we peel away to help relieve tension on the macular hole and allow it to close.  The gas bubble is then placed into the eye to help with the healing process and dissolves on its own over a period of weeks.  After the surgery, patients must maintain face-down positioning for the best chance of achieving hole closure.

Face-down positioning is often the most dreaded part of macular hole surgery.  Physicians recommend different lengths of face-down positioning, and it can vary from 3-7 days depending on the patient, the macular hole, and the physician.  There are positioning devices that your physician can recommend that can help with face-down positioning to make the process easier and more tolerable.

The success rate of macular hole surgery varies depending upon chronicity and size of the hole, but in many studies is greater than 90%.   However, even with closure, patients often notice that their vision is never "quite right" again.  Patients with macular holes of more than 6 months duration are less likely to have a successful treatment and less likely to regain significant vision after treatment.

This blog is not intended to be medical advice.  Please see a qualified medical professional for medical advice.

Ocriplasmin update

Macular holes and vitreomacular adhesions are conditions that can decrease vision in some patients.  Both of these conditions are caused by an abnormal adhesion of the vitreous to the macula.  Macular holes rarely spontaneously heal and usually require surgery.  Vitreomacular traction will occasionally spontaneously resolve, but it often requires surgery to improve the patient's vision.

Ocriplasmin is a recombinant form of an enzyme called plasmin.  It is designed to help dissolve the proteins that help link the vitreous to the macula, thus relieving the vision-reducing traction.

Phase 3 trials were recently published that revealed promising results.  After 28 days, following a single administration of ocriplasmin, resolution of vitreomacular adhesion was observed in 26.5% of patients compared to 10.1% in the placebo group.  Nonsurgical closure of macular holes occurred in 40.6% of ocriplasmin-treated patients, compared with 10.6% of patients on placebo.  While these numbers by no means allow every patient to avoid surgery, they do show that a single injection of Ocriplasmin may help some patients do so.

Ocriplasmin has not yet been approved by the FDA so is not yet available in the US. When it becomes available, NC Retina Associates will be offering this injection at all 5 of our locations.

This blog is for informational purposes only and does not constitute medical advice. Please seek advice of a qualified medical personnel. 


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