Shrinkage and movement of the vitreous can result in the formation of a hole in the center of the retina, known as a macular hole. The fluid which has replaced the vitreous gel in many areas may then seep through the hole, causing a localized separation of the retina centrally. This process results in a defect or dark spot in the central vision with distortion and central vision loss resulting. Symptoms of a macular hole include: decreased central vision for both distance and reading activities, distortion in central vision or a small defect in the central vision where small letters may disappear.
Until recently, very little could be done to correct the visual deficit resulting from macular holes. As a result of the introduction of microsurgical techniques, it is now possible to offer a surgical procedure with the potential for some visual improvement. This procedure is known as a vitrectomy, and involves the microscopic removal of the vitreous gel within the center of the eye. Particular attention is paid to removing any of the vitreous attachments from the macula, thus releasing the traction or pulling on the retina which caused the macular hole initially. This permits settling of the retina against the wall of the eye.