What is the macular hole? Explanations that were difficult to understand in the treatment room
“Macular Circle”
Hello, this is easy-to-understand ophthalmology story.
Today, after the last epiretinal membrane,
Let’s take a look at the “macular hole”, which is common in the macula due to old age.
Macular foramen is a disease that patients can suffer from because they often lead to surgery.
A macular hole that needs surgery before it’s too late
Let’s find out why it occurs, how to prevent it, and how effective the surgery is.
차례
macular hole definition
What is a macular hole
It is a hole that occurs in the macula, the central part of the retina, and refers to a defect in some or all of the retinal tissue .
The retina of our eyes is a thin film behind the eye that acts like a film .
The macula is the central part of the retina and plays a central role in vision .
A variety of macular disorders, including macular foramen, have a major impact on vision .
cause
In most cases, macular foramen occurs without any special ophthalmic disease or systemic disease .
This is called “idiopathic” .
Why does it happen for no reason?
The cause is the “aging of the vitreous body,” which was explained in the last occurrence of the epiretinal membrane.
The vitreous is the transparent jelly-like tissue that fills the eye .
It maintains the shape of the eyes and serves to protect the eyes.
–The vitreous body, structure and function. Jelly filled with snow.[link]
As we age, the vitreous also begins to age.
The vitreous that filled the eye elastically
It gradually becomes like water (liquefying the vitreous)
The portion of the retina that is attached to the retina will come off (posterior vitreous detachment)
look at the picture above
Like A, the vitreous that filled the eye
It goes through the aging process from B and C processes to D process, which is completely removed from the retina.
In this process, various retinal diseases can occur, and the macular hole is one of them.
The vitreous body attached to the macula
If the adhesion with the retina is strong, it may not come off easily.
The pulling force from the front continues to act,
The retina eventually attaches itself to the vitreous.
This is called “vitreous macular traction .”
Eventually, part of the retina in the macula is torn off.
A hole in the macula is a macular hole.
prevalence
based on the US
It is about 0.3% to 0.5% of the population over 55 years of age.
60-70 years old is the most common age.
The cause is unknown, but it is known to be more common in women than men .
Symptom
They show common symptoms of macular disease.
A typical example is when the center of the field of vision is blurred or when objects are distorted .
Symptoms may appear gradually or may appear suddenly .
It usually progresses slowly, but people may become aware of symptoms suddenly.
Humans have two eyes, so if one eye fails, the other eye compensates.
Always cover one eye to check for symptoms .
Diagnosis
If macular perforation is suspected through
Retinal examination will be the main diagnostic method .
In order to see the retina in detail, a mydriatic agent that enlarges the pupil is put and tested .
Large pores can be identified through a microscope .
As shown in the figure above, the part suspected of having a distinct hole in the macula is the macular hole.
However , a close examination is required to check the size of the hole and to what layer of the retina there is a defect .
A detailed examination of the macula is possible through Ocular CT (OCT), a tomography of the eye using light.
The normal macula has a concave shape as shown in the picture.
If the macula has a hole, you can see a hole in the center as shown above.
Macular Hole Stage
Depending on the degree and size of the macular foramen, it can be divided into stages 1 to 4 .
This is because the prognosis and treatment methods are different for each stage .
Until stage 1, the vitreous body is still attached to the macula, but the macula is deformed by traction.
Stage 2 is a state in which one retina is torn and attached to the vitreous, and the size is less than 400um.
The 3rd group is over 400um in size.
Stage 4 is a condition in which the vitreous is completely detached from stage 3
Once the macular foramen has progressed to stage 2, it usually progresses to stage 3 or 4 .
There is a report that 67% of the second stage macular disease progressed to stage 3 or 4 within 4 years.
Increased the size of the circle at 85%.
cure
In the case of stage 1 macular foramen, about 50% of cases show spontaneous improvement .
Therefore, in the case of stage 1, it can be monitored with careful follow-up, but if the symptoms are severe or
For stage 2 or higher macular foramen, treatment with drugs or surgery is considered .
non-surgical treatment
There is a procedure in which a drug called Orciplasmin is injected into the eye (intravitreal) .
This is a proteolytic enzyme that helps to facilitate posterior vitreous detachment , thereby solving the vitreous-retinal traction.
However, its effectiveness is limited and it is not a widely used drug.
surgical treatment
Surgical treatment of macular foramen
Vitrectomy, which removes the causative vitreous, is the main treatment .
For more information about vitrectomy, please refer to the link below.
– Vitrectomy, an explanation that is hard to hear in a hospital, I will give you. (Part. 1) [Link]
For reliable hole closure
with vitrectomy
- removal of inner boundary membrane
- gas injection
to implement.
By removing the inner limiting membrane, which is a thin film on the retina, the reliable traction force is removed and
Gas is injected to dry the retina around the hole , and the buoyancy of the gas makes both edges contact, so a higher surgical success rate can be expected.
surgical results
Recently, macular hole surgery has a success rate of about 90%.
Factors affecting the surgical outcome
- size of the hole
- Whether or not internal limiting membrane removal is performed
- prone position after surgery
there is
When the size was larger than 400um, the closure rate was lower.
The reason that the prone position is necessary after surgery is that in order for the gas bubble to contact the macular hole located behind the eye as shown in the figure below.
Because you have to lie down.
For the same reason as above , we emphasize the importance of prone posture to patients after macular foramen surgery .
This is also the part that patients struggle with a lot.
In fact, it is a very difficult posture even if you only have 6 hours with your face down.
Intractable macular hole
Although the success rate of surgical treatment for macular foramen is very high, about 90%,
In the case of a very large foramen or hole accompanied by other ophthalmic diseases
Since the surgical success rate is low, various methods are being tried.
Typically, there is a method of transplanting a part of one’s own mesh into the hole, and other methods such as amnion or autologous serum are introduced.
It is thought that further research is still needed.
Q&A
- Can a macular hole cause blindness?
When it develops into stage 3 macular foramen, central vision is significantly reduced.
If left untreated, a dangerous retinal detachment can occur, leading to blindness. - Doesn’t it heal on its own?
as described above
In stage 1, about 50% of cases block spontaneously.
However, once it progresses to stage 2, surgery is required because most of them continue to progress. - Can’t it be prevented?
does not exist.
The best way is to find it early through regular checkups. - How prone should I be?
It usually lasts about 14 days and may decrease or increase over time. - Can it recur after the macular foramen is blocked?
Very rare, but possible. - Can I have a macular hole after LASIK or LASEK?
Although highly myopia is rare, it can occur. (about 0.02%)
concluding
Learn more about the macular hole.
One of the most common diseases of the macula with aging
macular degeneration
– No worries about macular degeneration! It’s not that scary. (Definition & Kinds) (Part. 1)
epiretinal membrane
And to the macular hole today,
Next time, we will learn about a disease called “central serous choroidopathy” in which water builds up in the macula.
Thanks for reading this long post,
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