MACULAR HOLE

• Macular hole refers to a partial thickness or full-thickness hole in the neurosensory retina in the foveal region
• Straight lines or objects can begin to look bent or wave. A slight distortion or blurriness in their straight-ahead vision, which are gradually increasing are some common symptoms of macular hole

• Senile or idiopathic (83%), more common in females aged 60–80 years than males (F: M = 3:1).
• Traumatic macular hole accounts for (5%) cases
• Other causes of macular hole include cystoid macular oedema, vitreomacular traction, postsurgical, myopia, post-laser treatment, epiretinal membrane traction and post-inflammatory

Symptoms

• Decreased vision, typically around 6/60 level for a full-thickness hole and better for a partial hole
• Metamorphopsia or distortion of vision
• Central scotoma

Signs

Based on the fundus appearance the macular hole can be classified into four stages

• Stage 1 or impending hole - It is characterized by absent foveal reflex and a yellow spot or a yellow ring in the foveal region
• Stage 2- A small full-thickness hole is seen either in the centre or the ring
• Stage 3 -A full-thickness hole is seen as round reddish spot surrounded by a grey halo
• Stage 4 -Full-thickness hole

• OCT examination–reveals staging of macular hole
• Fundus examination (best examined with 78/90D slit-lamp examination- reveals early foveal hyper-fluorescence

• Stage 1- Treatment is not recommended as spontaneous hole closure can occur
• Stage 2 to 4 holes - Pars plana vitrectomy

Ayurvedic Treatment

Internal medications

• Triphala gritha + Triphala choorna + honey
• Patoladi gritha + Triphala choorna + honey
• Sapthamrutha lauha

Procedures

• Netra seka - Chakshusya drugs ( Darvi, Yasti, Triphala etc) in Burning sensation
• Jaloukavacharana - either forehead or eyelid at regular intervals
• Nasya - Ksheerabala avarthi, Dhanwanthara taila
• Anjana - Elaneerkuzhambu, Pasupatha varti
• Sirolepa - Chakshusya drugs
• Tarpana – Jeevaneeya gritha
• Putapaka -1 or 2 days