Macular Hole Surgery

Normal Vision
Vision with macular hole

What is a macular hole?

A macular hole is a small, circular gap which opens up at the centre of the retina. This causes blurred vision and often distorted vision where straight lines or letters look wavy or bowed. There may also be a patch of missing vision at the centre

Is a macular hole the same as age-related macular degeneration?

No, macular holes and macular degeneration are different conditions although they affect the same area of the eye. They can sometimes both be present in the same eye.

Why does it happen?

We do not know why macular holes develop. They most often occur in people aged 60-80, and are twice as common in women as men. We are increasingly aware that it is mainly slightly longsighted people who are affected. Other causes of macular holes include severe trauma to the eye, being very short sighted (myopic), those who have had a retinal detachment or as a result of longstanding swelling of the central retina (cystoid macular oedema).

What would happen if I did not have my macular hole treated?

If untreated, there is a small chance that some macular holes can close spontaneously, with improvement in vision. However, in the majority of patients the central vision will gradually get worse to a level where the patient is unable to read even the largest print on an eye test chart. The condition does not affect the peripheral vision, and so patients usually will not go completely blind from this condition

Can I develop a macular hole in my other eye?

Careful examination can assess the risk of developing a macular hole in the other eye. Your surgeon will tell you your risk but this may be from extremely unlikely to a 1 in 10 chance. It is very important to monitor for any changes in vision of the fellow eye, and report these to your eye specialist urgently.

What is the treatment & how successful is it?

A macular hole can often be repaired by an operation called a Vitrectomy, peel and gas. If the hole has been present for less than a year, the operation will be successful in closing the hole in about 90% of cases. Of these, more than 70% will be able to see two or three lines more down a standard vision chart, compared to before the operation. Even if this degree of improvement does not occur, the vision is at least stabilized, and many patients find that they have less distortion. In a minority of patients, the hole does not close despite surgery and the central vision can continue to deteriorate; however, a second operation can still be successful in closing the hole. It is important to understand that return to completely normal vision is not possible.

OCT Images of the retina before and after surgery

Does it matter how long I have had the macular hole if I am interested in having the surgery done?

There is evidence that relatively early treatment (within months) gives a better outcome in terms of improvement in vision. Studies have shown, however, that vision improvement may be possible in some patients with long-standing macular holes.

What does the operation involve?

Macular hole surgery is a form of keyhole surgery performed under a microscope, using 3 small incisions (1-2 mm in size) in the white of the eye for insertion of very fine instruments. Firstly the vitreous jelly is removed (vitrectomy), and then a very delicate layer (the inner limiting membrane) is carefully peeled off the surface of the retina around the hole to release the traction 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. The bubble of gas blocks the vision whilst it is present, but slowly disappears over a period of about 8 weeks

How long does the operation take and do I need to have a general anaesthetic?

Macular hole surgery usually takes 45-90 minutes and can be done with the patient awake using local anaesthetic, as a day case procedure. The local anaesthetic involves a numbing injection around the eye so that no pain is felt during the operation.

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