MACULAR HOLE
A round discrete hole in the center of the macula, resulting in loss of central vision, is a rarely encountered problem. It is more common in women than men by almost 2 to 1, and its occurrence peaks in the 7th decade. The cause is related to posterior vitreous detachment in possibly 2 ways: 1) the posterior vitreous layer, if adherent, may exert traction on the center of the macula when vitreous detachment occurs, 2) a layer of vitreous may remain adherent at the edges of the macula, and with time as it contracts, will cause a separation of the retinal layers resulting in a 'hole'.
Treatment with vitrectomy and peeling of the 'membrane', intravitreal gas 'to hold the retina in place' and proper prone positioning after surgery (which can be onerous) may be quite successful in closing the hole and improving vision.