Macular hole is a fundus disease with an incidence rate of 0.6-0.7%. It commonly occurs in the elderly, individuals with a history of ocular trauma, or those with high myopia. The macula is located at the center of the retina and is the most sensitive area for vision. Cone cells responsible for visual and color perception are distributed in this region. Therefore, any pathology affecting the macula can lead to significant central vision loss, dim or distorted vision. Macular holes are classified into lamellar holes and full-thickness holes, primarily arising from long-term macular cystoid edema caused by inflammation, trauma, toxicity, degeneration, or high myopia. Macular holes without other underlying causes are referred to as idiopathic macular holes.

Macular holes are generally categorized into three types:

1. Idiopathic macular hole;

2. Traumatic macular hole;

3. Macular hole associated with high myopia.

The latter two types may lead to retinal detachment, particularly in cases of high myopia combined with macular hole.

Treatment Methods for Macular Hole

In the past, due to limitations in surgical techniques, many macular holes could not be treated and were only managed with medications for so-called control. In reality, over 95% of macular holes can be cured through vitreous surgery, with an even higher cure rate for idiopathic macular holes, exceeding 95%.

Secrets to Successful Macular Hole Surgery

The key to successful macular hole surgery lies in two aspects: first, effectively relieving traction in the macular area by peeling off the internal limiting membrane, which is thinner than a cell; second, ensuring that patients strictly adhere to medical advice, maintaining a prone position for at least one week after surgery when the eye is filled with gas, to keep the macular hole area relatively "dry" and promote hole closure.

Our clinical observations indicate that over 85% of idiopathic macular holes close within one week after surgery, while approximately 70% close on the first postoperative day.

Prognostic Outcomes of Macular Hole

Many factors influence the visual prognosis after macular hole surgery, including the duration of the macular hole and the speed of photoreceptor cell recovery after healing. Additionally, the surgeon's skill plays a crucial role.

An excellent vitreous surgeon should prioritize the patient's visual recovery when treating macular holes, rather than merely completing the procedure. In my practice, I typically combine cataract surgery with macular hole surgery, as pre-existing cataracts tend to worsen significantly within two years after vitreous surgery, necessitating subsequent cataract surgery. Therefore, a successful macular hole surgery involves not only retinal surgery but also mature cataract surgical techniques. Another critical aspect is the concept of "protecting the macula." During macular surgery, although the procedure lasts less than an hour, I frequently turn off the surgical microscope's illumination and minimize the use of intraocular fiber optic lighting on the macula to avoid "phototoxicity." It is important to note that continuous light exposure to the macula during surgery can cause retinal damage comparable to staring directly at the sun.

Many patients achieve visual acuity better than 0.5 after macular hole surgery, but recovery is a gradual process that may take over six months. This primarily involves the recovery of photoreceptor cells, which may require adjunctive medication.