What is a macular hole?
This is a tiny hole in the centre of the macula. The macula is the area of the retina responsible for the central vision, and therefore a macular hole causes problems with loss of central vision. Symptoms may start as blurring or distortion of straight lines, faces and newsprint, progressing to a gap in central vision, although peripheral vision is preserved.
How does it develop?
The hole can appear due to contraction of thin membranes on the retinal surface or associated pulling from the adjacent vitreous gel. A macular hole is therefore usually due to a separation at the central and weakest point of the retina which “springs open” without any retinal tissue missing. This might explain why patients are often not aware of reduced vision until it is picked up at a routine optician visit, or discovered by accidentally covering the good eye.
The surgery is required to treat macular hole. This involves removing the vitreous gel from the eye (called “vitrectomy”) which allows the surgeon access to the macula to peel a membrane from around the hole. The space where the vitreous was located is now replaced by gas which slowly absorbs naturally without further treatment. The patient may be asked to “posture” face down for the night after surgery. Usually prolonged face down positioning is not required, but your Consultant will discuss this with you. Removing the vitreous gel is associated with cataract formation, and therefore cataract surgery is often performed at the same time as macular hole surgery, to speed visual recovery.
There is always a small risk with any operation, but the risks of developing another retinal problem such as retinal detachment, or of the macular hole failing to close, or re-opening later are all very small.
The gas bubble may take upto 4 to 6 weeks to spontaneously absorb (depending on the type of gas bubble used) during which time the vision is reduced. Recovery of vision after macular hole surgery is often slow and the accuracy (“acuity”) of vision will often continue to improve for many months after surgery, even upto 2 years.
How do I make an appointment?
Your Consultant’s secretary will be able to assist you with availability and costs for your chosen consultant. You can find their contact details by clicking on the link below or visiting the Consultants section.
For further information or to book a consultation contact: