Good Hope, Heartlands, and Solihull Eye Clinics

Case 17 macular hole

David Kinshuck

The patient attended the first postoperative visit after successful cataract surgery. Vision 6/18, and was 6/24 preoperatively. It is likely the hole was present for some time but could not be seen because of the cataract. Surgery is often helpful, although it is quite a major eye operation. An epiretinal membrane peel is needed to repair a macula hole.

a macular hole

an OCT scan showing a macula hole  enlarge

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a normal PVD

as the vitresou detaches it pulls the retina

The condition occurs as people get older. We do not know the exact cause, but It develops as the vitreous gel shrinks. See posterior vitreous detachment PVD.


A hole with good sight may progress. So a patient with 6/24 vision , for instance, may generally benefit from surgery. Expert advice is needed for individual patients.


Macular holes often follow the condition vitreo-macular traction (VMT). It is probably an advanced form of VMT.t is 'normal' for the vitreous to detach from the back of the retina as we get older. But in this condition, the vitreous is abnormally 'stuck' to the central part of the retina, and pulls it a little as it detaches, creating the tiny hole