Date issued: May 2021
Review date: May 2023
Ref: A-463/WS/Ophthalmology/Macular Holes
PDF: Macular Holes final May 2021.pdf [pdf] 473KB
How to contact
The Royal Eye Infirmary
Switchboard: 01752 202082
Eye Daycase Unit: 0845 439348
What is the macula?
Lining the inside of your eye is a thin sheet of nerves called the retina. The retina acts like the film in a camera by turning light entering your eye into a picture for your brain. The central part of the retina is called the macula. The macula is the most important part of the retina and is responsible for your best vision.
What is a macular hole?
A macular hole is when you develop an opening at the very centre of the macula. The hole starts off very small and gradually increases in size. The edges of the hole also lift up slightly.
Who is at risk of developing a macular hole?
Macular holes occur most frequently in those over the age of 65 years, and are also more common in women. There may be an increased risk of developing a macular hole in women who are on the oral contraceptive pill or on hormone replacement therapy.
Overall up to two people in a thousand may be affected.
Macular holes may also occasionally be caused by severe eye injury, severe short sightedness and retinal blood vessel problems.
What are the symptoms?
Patients with macular holes most commonly experience blurred central vision. They also commonly notice that things are distorted near the centre of their vision. These changes develop slowly causing a gradual deterioration in the quality of their vision. In some cases the macular holes are not initially noticed by the patient and are only picked up on a routine visit to the optician.
Although the central vision may be severely reduced, not all your vision will be lost because of a macular hole.
Some important points to remember about the gas in your eye
There are three very important things to remember during the four to six weeks that you have gas in your eye:
Do not lie on your back, unless instructed.Do not go flying in an aeroplane.If for any reason you require a general anaesthetic you must let the anaesthetist know that you have gas in your eye.
What is the treatment?
More recently a new product by the name of Ocriplasmin has been developed and then licensed in Europe for the treatment of vitreomacular traction associated early small macular holes.
Ocriplasmin is a chemical that breaks down some of the proteins present at the junction between the vitreous jelly and the retina. It is injected into the eye as a short simple procedure under local anaesthetic. It is expected that
Ocriplasmin would result in closure of approximately only 40% of suitable small early macular holes.
What can I expect after the vitrectomy surgery?
Your vision will be very blurred straight after the operation for over a month.
You will have to carry out something called “posturing” for between 10 to 14 days. Posturing means that you will have to spend all day looking straight down at the floor. You are only allowed 10 minutes break in each hour. At night you can sleep on your side. Please ask the nurses on the ward for advice on posturing.
There will be a number of eye-drops that you will have to regularly put into your eyes for about one month.
After two weeks you will notice a dark line across the middle of your vision. It will be clear above the line and blurred below the line. The line will gradually become more curved, until it becomes a dark circle at the bottom of your vision. This circle will gradually shrink until it finally disappears between four to six weeks after the operation.
What is the treatment?
Surgery or Ocriplasmin
An operation is the usual way to repair a macular hole. There is, however, a small chance that macular holes may repair themselves in certain situations.
The operation can be carried out under local or general anaesthetic and will involve removal of the jelly-like fluid in the eye which is then replaced with a bubble of gas. Membranes and scar tissues may also have to be removed from the surface of the macula. There is between 70-93% chance that the operation will close the hole.
Though your eye may feel sore after the operation, there should be little or no pain. As long as there are no problems you can go home on the day of surgery.
What are the main risks of the operation?
All patients who have not previously had cataract surgery will develop a cataract more rapidly.
One in a thousand chance of loss of vision from a severe eye infection.
One in a thousand chance of loss of vision from severe eye bleeding.
One in twenty chance of developing a retinal detachment.
Less than one in eight chance of the hole opening again.
How much vision can I expect after a successful operation?
If the hole closes there is up to a 77% chance that your vision will improve by 3 lines on the vision test chart. Your near vision would also improve and there would be less distortion of your vision.
It may take up to a year of gradual improvement until your sight gets to the best that it is capable of.
What happens if the macular hole does not close?
You would be offered the chance to have further surgery which again would have a good chance of closing the hole.
Occasionally, despite all efforts, it may not be possible to successfully close the hole.
Can macular holes be prevented?
Apart from avoiding injury to your eyes, there is no obvious preventative action that can be taken.
What about my other eye?
There is approximately a one in ten chance that you could develop a macular hole in your other eye.
What if my sight remains poor?
You can be helped to see many of the things you used to by making use of your remaining sight. Low vision services can help. They can help you find the best magnifiers for you, and can give advice and training about the many often simple ways that can make the most of your sight. Ask the eye specialist, optometrist (ophthalmic optician), GP, social worker or local voluntary organisation about low vision services near you. RNIB can also advise on the help that is available.