Macula Hole

What is a macula hole?

The retina is the layer of your eye that helps you see things. It is the equivalent of the film in a camera. The macula is the most sensitive part of your retina accounting for all of your fine central vision and colour perception. Occasionally, there can be a defect in the centre most point of your macula known as the macula hole.

What are the symptoms?

In the early stages, a macula hole can cause blurred and distorted vision. Straight lines may look wavy or curved, and you may have trouble reading small prints. As it progresses, patients start seeing a “missing patch” or a gap in their central vision. However, the condition rarely leads to total loss of sight and is painless.

How is it treated?

Treatment for full thickness macula holes is surgery with the aim of restoring the anatomy of the macula with a success rate of over 90%. Surgery is done with the primary aim of preventing further deterioration in vision. However, improvements are seen in a majority of patients but is dependent on the size and duration of the macula hole and can be variable. Even successful macular hole surgery rarely returns the vision to a level that the patient had prior to the development of the hole. Therefore, whilst surgery will usually result in symptomatic improvements, it is not a cure.



What does surgery involve?

Surgical treatment involves an operation to remove the vitreous jelly inside the eye in a procedure called vitrectomy, and careful peeling of the innermost layer of the retina – the Inner Limiting Membrane (ILM) and insertion of intraocular gas. The procedure can be combined with cataract surgery if there is a pre-existing cataract and takes about 1 hour. Surgery is either with a local or general anaesthetic but these options will be discussed in your initial consultation. Patients tend to be discharged same day following surgery with post-operative care instructions and eye drops to use. You will be requested to posture “face down” for 1-5 days after surgery as it has shown to help in closing the macula hole.

What can I expect after surgery?

Patients typically have poor vision for the first 4-6 weeks due to the presence of the gas bubble in their eyes and are not allowed to fly or go on high attitudes until after the gas bubble has fully dissolved. Patients are generally reviewed the next day and on week 2 and 6 from surgery.

Surgery is done with an aim to prevent further visual deterioration but tends to improve distortion and blurring of vision in a vast majority of patients. However, it rarely returns to the level the patient had prior to the onset of the problem. There are some patients that do not notice any improvement in their symptoms after surgery.


Figure: The image above shows the layers of the retina taken by an OCT scanner. In the image above, the scan shows the macula hole to have fully closed following successful surgery allowing the retina to return to its normal configuration. As a result of this operation, the patient had a significant improvement in his vision and regained enough vision to allow him to drive.


What if I don’t have surgery?

Very rarely, small full thickness macula holes can close spontaneously resulting in a visual improvement. Generally if no surgery is performed, the macula hole tends to increase in size with further corresponding deterioration in central vision and loss of the ability to see fine/large prints and fine details.


Vitreo Retinal Care Ltd, Registered Office: Kemp House, 152 – 160 City Road, EC1V 2NX (Company Number: 12866545 – Registered in England and Wales)

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