The macula is a tissue about 2mm in size between the upper and lower vascular arches in the posterior pole of the retina, and is rich in lutein, hence the name macula. The central macula, which has only the layer of cone cells, is the most important structure of the retina and the division of fine vision. Lesions in the macula directly affect the patient’s central vision and cause significant visual dysfunction. Previously, due to the limitation of technology, equipment and awareness, macular lesions lacked effective means of diagnosis and treatment, and most patients with macular lesions had poor prognosis. In recent years, with the emergence of a series of examination and treatment technologies such as OCT examination, ICG angiography, vitrectomy, photodynamic therapy and vitreous injection, the diagnosis and treatment of macular diseases are experiencing a leap forward. Here we mainly introduce the diagnosis and treatment of common macular lesions in the elderly. I. Age-related macular degeneration Age-related macular degeneration, also known as age-related macular degeneration (AMD), is a degenerative disease that occurs in the choroid, vitreous membrane and retinal pigment epithelium of the macula. According to the U.S. study, the prevalence of AMD is 9% at the age of 45-64, 10% at the age of 65-74, and 30% at the age of 75. In China, the prevalence of age-related macular degeneration in people aged 50-59, 60-69 and over 70 years old is 5.5%, 7.7% and 15.3% respectively. Clinical manifestations: Age-related macular degeneration is clinically divided into two types: atrophic (dry) and exudative (wet). Atrophic age-related macular degeneration is characterized by progressive retinal pigment epithelial atrophy and photoreceptor degeneration, causing central vision loss, published simultaneously in both eyes, and slow vision loss. Exudative macular degeneration is characterized by the formation of subretinal neovascularization (CNV), which causes a series of fundus changes such as hemorrhage, edema, exudation and scar formation in the macula. In the early stage, it may manifest as blurring of objects and distortion of vision. When there is hemorrhage and exudation, the central vision can be drastically reduced. Late stage lesions end with scar formation and the patient loses central vision. Diagnosis: The diagnosis of age-related macular degeneration is based on fundus examination, fluorescein fundus angiography (FA), choroidal angiography and OCT. In atrophic macular degeneration, the fundus shows vitreous membrane warts and atrophic changes of retinal pigment epithelium, and there is no CNV formation, exudation, edema and hemorrhagic changes on FA, ICG and OCT. In exudative age-related macular degeneration, hemorrhage and exudation can be seen in the macula, and CNV can be seen on FA, ICG and OCT. atrophic age-related macular degeneration can develop into exudative macular degeneration. Using the Amsler table, patients can perform self-examination to detect the progression of fundus lesions in time. Treatment: The treatment of age-related macular degeneration depends on the type. The main goal of treatment for exudative age-related macular degeneration is to control the CNV and make it shrink and fade away. The biggest difficulty of treatment is not to damage the healthy tissue in the central macular recess. The current treatment method is mainly photodynamic therapy. Photodynamic therapy is highly selective and can control the growth of CNV with less damage to normal retina, which is a safe and effective treatment method. However, one photodynamic therapy cannot completely cure exudative age-related macular degeneration, and usually requires several treatments to keep the lesion in a relatively stable state, and expensive is its disadvantage. Vitreous injection of anti-vascular endothelial growth factor (VEGF) is a new technique for the treatment of exudative age-related macular degeneration. Clinical studies have shown that this method can reduce macular edema, control the development of CNV and improve the visual acuity of some patients. Currently, domestic and international fundus specialists and scholars are exploring photodynamic therapy combined with vitreous injection of anti-VEGF for the treatment of age-related macular degeneration, and preliminary clinical studies have shown good prospects. Macular retinal transplantation and pigment epithelial transplantation is one of the methods of surgical treatment for exudative macular degeneration. It has not been popularized due to its technical difficulty and limited visual acuity results. Laser retinal photocoagulation is only suitable for a few cases where the lesion is outside the central recess. There is no specific treatment for atrophic age-related macular degeneration, but antioxidants, such as vitamin C, vitamin E, zinc and lutein, can be taken. In recent years, a combination of antioxidants, zinc and lutein has been developed to help slow down the development of the lesion. Idiopathic macular fissure Macular fissure can occur at any age and can be secondary to a variety of fundus pathologies, such as high myopia, trauma and long-term macular edema. Idiopathic macular fissure refers to the macular fissure without obvious cause, and the macular fissure appears when the fundus itself is investigated, accounting for most of the macular fissures. In recent years, it is believed that vitreous concentration and coalescence are important causes of macular fissure formation. Clinical manifestations: The prominent clinical symptoms of macular fissure are loss of central vision, visual distortion and self-perceived central dark spot. The degree of vision loss depends on the size and location of the fissure. According to the process of fissure occurrence, there are clinical stages I-IV. In early fissure, the patient’s visual acuity is mildly reduced, and if a full-layer fissure is formed, the central visual acuity is sharply reduced, usually around 0.1. Diagnosis: A round or oval sharply edged hole can be seen in the center of macula on fundus examination. defect of retinal neuroepithelial layer in the center of macula can be seen on OCT examination. translucent fluorescence can be seen on FFA angiography. Treatment: Treatment of macular fissure is based on vitrectomy surgery. By removing the vitreous, peeling off the inner retinal boundary membrane, releasing the retinal tangential line pull, and promoting the healing of the fissure. Stage I macular fissure needs clinical observation, while stage IV macular fissure does not need surgery if retinal detachment does not occur because there is no chance of healing. 3. Macular retinal anterior membrane Macular retinal anterior membrane is a fibrous proliferative membrane growing on the inner surface of the retina, which can be secondary to a variety of fundus lesions or can occur independently called idiopathic macular retinal anterior membrane. Idiopathic macular preretinal membrane is most commonly seen in the elderly, with a prevalence of 3.5-5.5% in older patients. In recent years, due to the emergence of OCT examination technology, the early diagnosis of macular preretinal membrane has been improved. Clinical manifestations and diagnosis: The proliferation and membrane contraction of the anterior macular retina cause pulling on the retina resulting in retinal folds and edema. In the early stage of the disease, the anterior retinal membrane is thin and the pulling force on the retina is weak, so patients have no obvious conscious symptoms. Fundus examination and OCT examination can clarify the diagnosis, and OCT examination can show the relationship between the anterior macula and retina and the degree of retinal traction in the retinal section, which can help judge the condition and guide the treatment. Treatment: Mild macular preretinal can be observed clinically. Severe cases require vitrectomy surgery for treatment. By surgically stripping the preretinal membrane, the retinal deformation is improved and the patient’s vision is improved.