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What Is a Macular Hole?

A macular hole is a small opening in the very centre of the area of the retina called the macula.

This hole can cause the central part of your vision to be missing, distorted, or blurred.

The condition does not lead to a total loss of vision and is not painful.

How Does a Macular Hole Occur?

Macular holes are commonly found in patients between 60 and 75 years of age and are more common in females. As we age, the vitreous humour (the gel inside the eye) starts to liquefy and collapse. It pulls on the retina and macula, in some patients, causing a hole.

Macular Hole – Pre-treatment (Figure 1 above shoes a macular hole pre-treatment)

What Is the Treatment for A Macular Hole?

The most common course of treatment is to have an operation called a Vitrectomy.

During this procedure, the gel inside the eye is removed, and the retinal tissue on the surface of the macula is peeled and placed into the hole to fill the gap. An air or gas bubble is injected to encourage the macular hole to close.

Macula Hole – Post-treatment (Figure 2 shows macular hole post-treatment)

Follow-Up After Treatment

To ensure the macula has the best chance of healing you may be asked to assume a face-down position (known as posturing) for 24 hours after surgery.

This allows for the bubble of air or gas and the macular hole to maintain full contact.

Initially, the vision in your eye will be very poor. Approximately 7-15 days after the treatment, the bubble starts to shrink and will be replaced by the natural fluid produced by your eye. As a result, your vision will start to improve.

Vision can take several months to improve to its maximum potential. Early diagnosis is very important as final vision quality can be dependent on how long the hole has been present and its size, amongst other factors.

You must not fly or travel at high altitude or drive until the bubble has been sufficiently absorbed. The typical waiting time for this is around 4-6 weeks, however, Prof. Stanga will confirm this with you at your consultation.

Possible Complications

The hole fails to close – This can lead to worse vision than before surgery. It is, therefore, possible that the surgery may need to be repeated.

  • Retinal detachment – The retina can detach from the back of the eye resulting in complete vision loss. However, this can usually be repaired with a further procedure.
  • Bleeding – This occurs very rarely and could cause complete loss of vision if severe enough.
  • High pressure – If the pressure in the eye goes very high for a short period of time or goes slightly up for a prolonged period of time the optic nerve can be damaged resulting in partial or complete and permanent loss of vision.
  • Cataract formation – It is almost certain that a cataract will develop within 36 months of this operation. If a cataract is already present it can be removed at the same time.
  • Infection –This occurs very rarely and would require urgent treatment. This can lead to complete and permanent loss of vision, if not treated.


Prof Stanga will be reviewing you frequently to ensure the eye is healing well. If you notice any sudden change to your vision, pain, redness, or unusual discharge you must contact The Retina Clinic London.