Macular Hole surgery is a form of keyhole surgery performed under a microscope, using 3 small incisions (1-2mm in size) in the white of the eye for insertion of very fine instruments. Firstly, the vitreous jelly is removed (vitrectomy), and then a very delicate layer (the inner limiting membrane) is sometimes carefully peeled off the surface of the retina around the hole to release the traction forces that keep the hole open. In complex cases, the inner limiting membrane may be used to fill the macular hole and improve closure. The eye is then filled with a temporary gas bubble, which presses against the hole to help it seal. The bubble of gas blocks the vision whilst it is present, but it slowly disappears over a period of about 2-12 weeks.
[British and Eire Association of Vitreoretinal Surgeons – Macular Hole ]
Macular Hole before (L) and after (R) surgery at My Eye Clinic
Macular hole surgery usually takes 45-90 minutes and can be done with the patient fully awake (local anaesthetic), or sedated, as a daycase procedure. Most patients opt for local anaesthetic, which involves a numbing injection around the eye so that no pain is felt during the operation; this is sometimes supplemented with medication to reduce anxiety (sedation).
Following surgery some patients will be asked to posture face down to keep the gas bubble in contact with the hole as much as possible to encourage it to close. Whether you are required to posture, and for how long, will depend on the size of the macular hole, and also the preference of your surgeon. There is evidence that posturing improves the success rate for larger holes, but it may not be needed for smaller holes.
You must not fly or travel to high altitude on land whilst the gas bubble is still in the eye (up to 12 weeks). If ignored, the bubble will expand at altitude, causing very high eye pressure resulting in severe pain and permanent loss of vision.
Most people will need two weeks off work following macular hole surgery. Your vision is reduced while the gas bubble is in the eye, and this also affects depth perception. However, it depends on the type of work you do and the speed of recovery. This should be discussed with your surgeon.
Most People will need to change their spectacle prescription at some point after surgery. This would normally be at about 3 months following the operation, after the gas bubble has gone.
My Eye Clinic can provide expert consultant assessment of retinal problems including macular holes.
My Eye Clinic has a full range of diagnostic equipment for assessing macular holes with detailed OCT scans of the macula.
My Eye Clinic has a new operating theatre fully equipped with the latest generation cataract machine (Alcon Centurion Gold), an excellent operating microscope and a new (Dorc Nexus) combined cataract and vitrectomy machine.
Mr Habib has a special interest in macular hole surgery, epiretinal membrane (ERM) surgery, surgery for vitreous floaters, and treating complicated cataracts. Mr Habib has been a Consultant Ophthalmologist and Vitreo-retinal Surgeon at Sunderland Eye Infirmary since 2011. He is an Honorary Clinical Senior Lecturer at Newcastle University.
Kadambari Oswal is a Consultant Ophthalmic and Vitreoretinal surgeon who performs complex/high-risk cataracts and vitreoretinal surgeries including retinal detachment surgeries, macular holes, epiretinal membranes.
Tafadzwa Young-Zvandasara MBChB (Dundee), MSc (Engineering), MIET, FRCOphth (UK), MAcadMEd is leading Consultant ophthalmologist specialising in Vitreoretinal and Cataract surgery in the North East of England. He specialises in Retinal surgery, Cataract surgery and Retinal conditions.
Inclusive prices include post-operative medicines and follow-up appointments:
It is unlikely that you will suffer harmful effects from a macular hole operation. In a small minority, the vision may end up worse than before the surgery, and there is even a tiny risk of total loss of sight. Six specific complications of macular hole surgery, which you must be aware of, are outlined below:
[British and Eire Association of Vitreoretinal Surgeons – Macular Hole]
This occurs in 1-2 out of 10 patients. In most circumstances, it is possible to repeat the surgery. Repeat surgery may involve extra measures (such as filling the macular hole) to improve the chance of hole closure. If the hole fails to close, then the vision may be a little worse than prior to the surgery.
This means that the natural lens in the eye has become cloudy. If you have not already had a cataract operation, there is a ⅘ chance you will get a cataract after the surgery, usually within a year or two but it can happen very rapidly. You may be offered combined surgery with cataract extraction at the same time as the macular hole repair.
The retina detaches from the back of the eye in 1-2% of patients undergoing macular hole surgery. The vast majority of retinal detachments are repairable, but further surgery is required, and this can be a potentially blinding complication.
This occurs very rarely, but severe bleeding within the eye can result in blindness.
This is also very rare and would be expected to occur in about 1 in 1000 patients, but if it occurs it needs further treatments and it can lead to blindness.
An increase in pressure within the eye is quite common in the days after macular hole surgery, usually due to the expanding gas bubble. In most cases it is short-lived and controlled with extra eye drops and/or tablets to reduce the pressure, preventing any harm to the eye. If the high pressure is extreme or becomes prolonged, there may be some damage to the optic nerve as a consequence. In the majority, this damage does not adversely affect the vision, but some patients require long-term treatment to keep the pressure controlled.
