Macular Hole Surgery - Helios Vision

What is a macular hole?

A macular hole is a small gap in the macula, the central part of the retina responsible for your sharp, detailed vision. When a hole forms, the fine central vision is affected, so straight lines can look bent or wavy, and there may be a blurred or missing patch right in the middle of what you are looking at, while the surrounding vision stays normal.

Macular holes usually develop because of changes in the vitreous gel that fills the eye, which can pull on the delicate centre of the retina as it naturally shrinks with age. They are more common in later life and slightly more common in women. Because the macula is responsible for the vision you rely on most, a macular hole can make everyday tasks such as reading difficult, even though the side vision is unaffected. The condition is diagnosed with a detailed scan of the retina, called an OCT scan, which shows the hole clearly and helps plan treatment. The encouraging news is that macular hole surgery is generally very successful at closing the hole, and treating it sooner rather than later gives the best chance of improving vision. Your consultant will explain the size and stage of your hole and what that means for your treatment.

What macular hole surgery involves

Mr Paritosh Shah performs a vitrectomy and places a gas bubble to support the macula as it heals. During the operation, the vitreous gel is removed through tiny openings, and a very fine layer on the surface of the retina, called the internal limiting membrane, is gently peeled away to release the tension around the hole and encourage it to close. A gas bubble is then placed in the eye to hold the edges of the hole together while it heals.

The surgery is carried out in Yeovil, usually as a day case under local anaesthetic, so the eye is numbed and you stay comfortable. After the operation, you may be asked to keep your head in a particular position for a period of time, because this helps the gas bubble press gently on the macula and support healing. You will not be able to fly while the gas bubble is present, as changes in altitude can affect it, and your consultant will tell you when it has cleared. Because the same specialist assesses, operates on and reviews your eye, your care stays joined up from start to finish, and you will be given clear guidance on posturing and recovery.

What to expect on the day of your macular hole surgery

Macular hole surgery benefits and considerations

Surgery closes most macular holes and can improve central vision over the following months, and for many people it restores enough detailed sight to make reading and other close tasks easier again. The sooner a hole is treated, generally the better the outcome, which is why prompt assessment is encouraged.

Recovery often involves posturing and avoiding flying until the gas has cleared, and your consultant will explain exactly what is needed for your eye. Vision usually improves gradually rather than immediately, and it can take several months to see the full benefit, with the amount of improvement depending on the size of the hole and how long it has been present. As with any eye surgery there are risks, including the development or progression of a cataract, a rise in eye pressure, and, uncommonly, a retinal detachment or the hole not closing fully, all of which are discussed with you beforehand. Occasionally a further procedure is needed. Outcomes cannot be guaranteed, but macular hole surgery performed by an experienced vitreoretinal consultant has a high success rate for closing the hole. If your central vision has become blurred or distorted, a retinal assessment in Yeovil will confirm whether a macular hole is the cause.