Macular Hole

Macular Hole

What is a macular hole?

The retina is the thin layer of nerve tissue lining the back of the eye. The retina functions much like the film in a camera and transmits light signals to the brain. The central and most sensitive part of the retina is called the “macula”.

A macular hole is a hole in the macula (central part of the retina). Normally, the eye is filled with a gel-like substance called the “vitreous”. As we age, the vitreous shrinks and in the majority of people, it does not cause any problem and no damage to the vision. In some people, the vitreous is adherent to the macula and when it pulls away from the central part of the macula, can cause a hole to form.

What are the symptoms?

If a macular hole develops, you will be aware of a dark spot or a gap or blurring in the centre of your vision. You may be aware of reduced vision especially for reading. You may also experience some distortion of straight lines in the central vision, or letters from a page of writing can seem to disappear.

What is the treatment for macular hole?

The only treatment for macular hole is a surgery called “vitrectomy”. Eye drops or stronger glasses are ineffective. This surgery involves removing the gel inside the eye using very small instruments. The is combined with removing a thin layer on the surface of the retina called the “internal limiting membrane” with the aid of fine micro-forceps. At the end of the operation, the surgeon often puts a bubble of gas inside the eye to help the hole to close. Then you will be instructed about a certain posture after the surgery. The gas usually disappears in a few weeks.

Vitrectomy surgery is performed with the aid of local anaesthetic (small injection of anaesthetic solution around the eye) as a day surgery. Your eye will be numbed and you will not feel any pain, although you may feel some pressure sensation during the surgery. The surgery often takes about 45 minutes. The surgery is often combined with cataract surgery if you have a cataract. Mr Ellabban will discuss with you the details of the surgery and advise you about the procedure.

What is the chance for the hole to close after the surgery?

The success of the surgery depends on many factors like the size of the hole, duration of the hole and if any associated other retinal conditions. With modern technology, the success of macular hole surgery is more than 90 %. Based on the initial assessment, the surgeon will be able to advise you regarding the outcome of the surgery.

Will my vision recover completely after the surgery?

When the hole closes after the surgery, you will usually regain a large part of the vision. This usually takes a few weeks to months to reach the final improvement as the hole heals completely. You will be monitored with the aid of OCT scans of the retina to monitor the healing process and restoration of the retinal layers. Also, the central blurring and distortion will gradually improve after surgery, however, it will not be completely restored as normal.

Before Surgery

After Surgery

Will I need to posture after the surgery?

Mr Ellabban will advise if it is necessary for you to posture after your surgery. If required, posturing is usually for 7 days after the surgery. Actually, this can be the hardest part of the recovery following your surgery, but the most important. In all situations, you will be instructed not to lie on the back after the surgery for the first 1-2 weeks.

If you have gas inside the eye, you will be instructed not to fly for a few weeks till the gas completely disappears.

What are the risks of the surgery?

Vitrectomy surgery has similar risks as other types of eye surgery such as:

  • Infection
  • Prolonged Inflammation
  • Bleeding
  • Retinal detachment
  • Increased eye pressure
  • Distortion or alteration of vision

However, serious side effects are uncommon. There is a very small risk (less than one in 1,000) that you could lose the sight in the eye as a consequence of the operation.

What will happen afterwards?

Mr Ellabban will arrange a review after the surgery, to monitor the healing process of the retina. You will be monitored with the aid of retinal scans to assess the healing process and restoration of the retinal layers.

Before Surgery

After Surgery

What I need to do after the surgery?

You are advised to follow the instructions you were given after the surgery by Mr Ellabban and the nursing team particularly if you were asked to follow a certain posture after the surgery.

In general, there are important points to follow, after retinal surgery:

  • Put the drops as regularly as you were instructed.
  • Avoid rubbing your eyes for 1 week.
  • Avoid heavy lifting and straining for 1 week.
  • Avoid getting soap or shampoo or chemicals into your eye for 4 weeks.
  • Avoid swimming for 12 weeks.
  • You must not drive until you reach the minimum legal standard of vision.
  • It is normal for the eye to appear red or uncomfortable for few days after the surgery which will gradually get better over time.

What if I don’t have surgery?

If no surgery is performed, the hole may continue to enlarge with further deterioration in the central vision. Also, if the surgery is delayed, this may affect the final outcome of the surgery.

Rarely, small macular holes may close spontaneously. The chance for that is less than 5 %. Mr Ellabban will arrange a retinal scan and will be able to advise you about the type of your macular hole.