Most macular holes occur in the elderly. When the vitreous(the gel-like substance inside the eye) ages and shrinks, it can pull on the thin tissue of the macula, causing a tear that can eventually form a small hole. Sometimes injury or long-term swelling can cause a macular hole. No specific medical problem is known to cause macular holes.
Vitrectomy surgery, the only treatment for a macular hole, removes the vitreous gel and scar tissue pulling on the macula and keeping the hole open. The eye is then filled with a special gas bubble to push against the macula and close the hole. The gas bubble will gradually dissolve, but the patient must maintain a face-down position for one to two weeks to keep the gas bubble in contact with the macula. Success of the surgery often depends on how well the position is maintained.
With treatment, most macular holes shrink, and some or most of the lost central vision can slowly return. The amount of visual improvement typically depends on the length of time the hole was present.