www.goodhope.nhs.uk/departments/eyedept/
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Good Hope Hospital Eye Clinic
 

Macular holes and foveal cyst
David Kinshuck

 

 

Macular hole

A macular hole is a hole in the very centre of the retina, in the fovea. (The fovea is the centre of the macular area,)

Vision is reduced. A patient with new hole may have about 6/12 vision, and when trying to read a word may notice a few letters missing.

Surgery is often helpful, although the operation is quite a major. An epiretinal membrane peel is needed to repair a macula hole.

Without surgery the hole may progress and ultimately reduce vision to ~6/60. Therefore surgery is recommended for most well patients, if the sight is still good.

a macular hole

an OCT scan showing a macula hole  enlarge

 

A foveal cyst like the one below may be is an early stage of a hole.

See related pages

 

Causes

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.

Macular holes often follow the condition vitreo-macular traction (VMT). It is probably an advanced form of VMT.

 

It 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

 

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.

a normal PVD

as the vitresou detaches it pulls the retina

 

 

 

Foveal cyst

The fovea is the centre of the macula, and this may develop a cyst as below. Some cysts are due to macular oedema/inflammation as in diabetes, but others are 'early' macular holes as the one shown here. Unless a hole does develop, surgery is not usually needed.

Causes are the same as macular hole as above.

a foveal cyst, sometimes develops into a macular hole

a foveal cyst, sometimes develops into a macular hole

 

Macula hole/cyst

A patient

  • Age 67, female
  • 2011 May 6/18 right, foveal cyst, top photos
  • 2012 Jan 6/36 macula hole, bottom photos. Patient referred, hole closing, no surgery needed.

macula hole

macula hole 6 months later

home   Case 1: PED/CNV      Case 2: hard drusen       Case 3: CSR     Case 4 CNV      Case 5 Occult      Case 6 soft drusen     Case Pre-macula haem     Case Bests    Case 10  PDT  Case 11 rip    Case 12 CNV   Case 13 CSR & PED    Case 14 Dry/Occult     Case 15 polypoidal    Case 16 myopic early CNV      Case 17 macula hole    case 18 more fluid with oct       case 19 fluid reaccumulates      Case 20 peds & nsd      Case 21 AOFVD  Case 22 AOFVD/ERM    Case 23 speckles    case24 VMT      case 25 epiretinal membrane
The address of this site ('org' changing to 'nhs') is changing from http://www.goodhope.org.uk/departments/eyedept/ to http://www.goodhope.nhs.uk/departments/eyedept/
Eye website feedback -- Heartlands -- page edited October 2011 -- Public transport to Good Hope --