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What causes a macular hole? The macula is the central portion of the retina, the light sensitive layer at the back of the eye. A hole occurs when the vitreous gel collapses away from the surface of the retina, exerting traction on its center. Symptoms include a decrease in vision and distortion. How is the macular hole treated? The macular hole can be treated with an outpatient operation performed with local anesthesia. A vitrectomy is performed, removing most of the vitreous gel from in front of the retina. A temporary bubble of gas is injected to flatten the macula and close the hole. Because the gas bubble rises to the highest part of the eye, and because it is necessary to press on the back part of the eye, the patient must keep his face down, 24 hours a day, for a week after surgery. How successful is the operation? The operation closes the macular hole 80 to 90% of the time, and vision is improved in most of the successful cases. If the patients own lens is present, this operation will likely cause clouding of the lens, a cataract, which will require another operation. Of course, with any operation, severe, rare complications, such as infection or hemorrhage, can permanently decrease vision. What if nothing is done or the operation is not successful? As time passes, the hole can increase in size, with some further decrease in vision. However, the vision typically stabilizes, and total blindness is not expected.

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