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, so any lesion involving the macula can lead to significant central vision loss, dim vision, and visual distortion. Macular holes are classified into lamellar holes and full-thickness holes. They primarily develop from long-term cystoid macular 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 a 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 vitrectomy, with idiopathic macular holes having an even higher cure rate of over 95%.

Key to Successful Macular Hole Surgery

The success of macular hole surgery hinges on two critical factors: first, effectively relieving traction in the macular area by peeling the internal limiting membrane, which is thinner than a cell; second, the patient's strict adherence to medical advice, particularly maintaining a prone position for at least one week after surgery when the eye is filled with gas. This helps keep the macular hole area relatively "dry" and promotes hole closure.

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

Prognosis of Macular Hole Surgery

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

An excellent vitreoretinal surgeon should prioritize the patient's visual recovery when treating macular holes, rather than merely completing the procedure. In my practice, I often combine macular hole surgery with cataract surgery, as cataracts tend to worsen significantly within two years after vitrectomy, necessitating subsequent cataract surgery. Therefore, a successful macular hole surgery involves not only retinal surgery but also mature cataract surgical techniques. Another key consideration is the concept of "protecting the macula." During macular surgery, although the procedure typically takes less than an hour, I frequently turn off the surgical microscope's illumination and minimize the use of endoillumination 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 is primarily due to the slow recovery of photoreceptor cells, which may require adjunctive medication.