Macular hole treament

The eye is like a camera with a lens and film in the eye. The retina is the light sensitive film at the back of the eye and the macula is the important central part of the retina, responsible for fine detail, reading and colour vision. A macular hole is the development of a small defect in the centre of the retina. This causes blurred vision, distorted vision and sometimes a patch of missing vision in the centre. It is unlikely for this condition to cause blindness, but if untreated the central vision will be get worse even to read large prints.

We do not know why macula holes develop; however, they tend to occur is patients over 60 years old and it typically affects women more than men. Other causes include severe trauma, being short-sighted, those who have had a retinal detachment or following longstanding macular swelling. The risk of developing macular hole in other eye rare to a chance of 1 in 10.

Macula hole can be repaired by an operation called a vitrectomy, peel and gas. This involves a surgical procedure whereby the vitreous jelly is removed from inside the eye, then a delicate layer (Inner limiting membrane) is carefully peeled from the centre of the retina to release the tractional forces that keep the hole open. The eye is then filled with a temporary gas bubble, which presses against the hole to help it seal. This surgery can be performed under local or general anaesthesia as a day case procedure which usually takes about an hour.

With a gas bubble in the eye, your surgeon may ask you to posture after the operation for up to 7 days. Posturing involves placing your head in a face-down position to allow the gas bubble to float into the best position to be in contact with the hole to encourage it to close. You will be required to posture up to 45 – 50 minutes of every hour during the day. The remaining time of every hour can be spent moving around as normal. Posturing after the operation is an important second stage of surgery but if you are unable to posture, still there is a good chance for the hole to close. You must not fly or go high altitude until the gas bubble disappears and you must inform your anaesthetist if you require a general anaesthesia for any operation while there is gas in your eye

As with any procedure, there may be risks involved and you should discuss this with your surgeon before you give consent for surgery.
Common complications to be aware of include:
  • Failure of macula hole to close in 10 to 20%
  • Cataract (clouding of the natural lens of the eye, sometimes cataract is also removed at the same time as macular hole surgery)
  • Retinal detachment in 1 – 2%
  • Bleeding – very rare but if severe it can result in blindness
  • Infection – very rare about 1 in 1000, but can lead to blindness
  • Persistently raised eye pressure in about 1%

Macula hole surgery is a major operation and it is normal to experience some discomfort in the eye following surgery.  You will be given specific posturing instructions which need to be followed after surgery. The white of the eye may appear red with swelling to the eyelid. You may have some watering of the eye and a gritty sensation in the eye which slowly disappears in few days. You will be given eye drops to be used for four weeks.  You can shower or bath but avoid getting water directly into the eye. Abstain from unhygienic environments and anything that puts the eye at risk of injury.

You will be reviewed usually after one week and again after 4 weeks. Vision in the eye will be blurred for a few weeks after the operation but it should improve slowly over time. Your surgeon will discuss your final expected visual outcome of your surgery. If you have any concerns, please discuss this with your surgeon.

You will need rest from work for about two weeks. We advise against driving for the first few weeks while gas bubble is in the eye. However, any work-related concerns should be discussed with your surgeon.

Normal macular
Normal Macula
Hole macular
Full thickness macular hole
Where can I find further information?
Understanding macula hole surgery can be complicated. The information given above will not cover all the concerns you may have about this procedure. Further information can be found at the following websites:
https://www.nhs.uk/conditions/macular-hole/
https://www.rnib.org.uk/eye-health/eye-conditions/macular-hole

Scientific evidence:
The information mentioned here is based on a variety of sources, including latest published research and the Britain & Eire Association of Vitreoretinal Surgeons.

This must not be used as a substitute for professional medical care by a qualified doctor or other health care professional. Always check with your doctor if you have any concerns about your condition or treatment.  We are  not responsible or liable, directly or indirectly, for ANY form of damages whatsoever resulting from the use (or misuse) of information contained in this page or found on web pages linked to from this page.