Macular hole surgery is the vitreoretinal procedure used to close a full-thickness defect in the macula, the central region of the retina responsible for detailed central vision. A macular hole develops most often from tangential and anteroposterior traction exerted by the vitreous and the internal limiting membrane…
Macular hole surgery is the vitreoretinal procedure used to close a full-thickness defect in the macula, the central region of the retina responsible for detailed central vision. A macular hole develops most often from tangential and anteroposterior traction exerted by the vitreous and the internal limiting membrane at the foveal centre, producing a break that causes central blurring, distortion (metamorphopsia), and a central scotoma. Optical coherence tomography is the principal tool for diagnosis and staging, defining hole size and configuration, which guide surgical planning and prognosis. The standard operation is pars plana vitrectomy, in which the vitreous is removed to relieve traction; this is typically combined with peeling of the internal limiting membrane to release residual tangential forces and promote closure. The eye is then filled with a gas or air tamponade, and postoperative positioning, often face-down, helps appose the hole margins while it seals. Anatomical closure rates are generally high, with visual recovery influenced by hole size, chronicity, and macular health. Variations in technique, including adjuncts for large or persistent holes, continue to be refined. As a representative example of modern vitreoretinal microsurgery, macular hole surgery illustrates how relieving mechanical traction and providing tamponade can restore foveal architecture and improve central vision.
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