Macular hole

What causes a macular hole?

Several eye problems can affect the macula and lead to loss of central vision if they are not treated. These include a macular hole, macular pucker (epiretinal membrane), and macular oedema. It’s not always clear what causes a macular hole, although it can be linked with other conditions like:

• Long lasting swelling of the macula (known as cystoid macular oedema)

• An eye injury

• Retinal detachment

• Having long sight (hyperopia)

• Having severe short sight (myopia)

Another cause is linked to changes to the gel‑like fluid that fills the eye, called the vitreous, that is attached to the retina by lots of tiny fibres. As we get older, the vitreous begins to shrink and starts to pull away from the retina – this is completely normal and usually doesn’t cause any problems.

It is thought that as the vitreous jelly comes away from the back of the eye (a process known as posterior vitreous detachment), areas more firmly attached to the retina may tug the macula enough to form a small hole.

Surgery for macular hole

If the macular hole is in the early stages, ophthalmologists will often choose to monitor you for any changes over time.If treatment is needed, it will usually involve surgery which aims to repair the hole and improve your vision. However, in the vast majority of cases, your vision will not get back to normal.

​Vitrectomy

This is the main part of the surgery to repair a macular hole. The operation involves removing the vitreous gel inside the eye and replacing it with a gas bubble to help the macula to heal. Taking the vitreous out stops it from pulling on the retina anymore, and the bubble lightly presses on the hole to encourage it to heal – a bit like a bandage.

The gas bubble will make your vision quite blurry, but over a few weeks the bubble will get smaller and eventually go away altogether. During this time, the eye will naturally produce some more fluid to replace it.

Recovering after macular hole surgery

You’ll be given some eye drops to use for a few weeks, and it’s best to avoid rubbing your eye, wearing eye make‑up, going swimming or doing strenuous exercise while you’re recovering.

While the gas bubble is in your eye, your vision will be quite poor – so you won’t be able to drive for a few weeks and you’ll need to be careful with your day‑to‑day activities.

It’s very important that you don’t fly or go to high altitudes until the bubble has disappeared, as the pressure causes the bubble to expand, which can permanently affect your vision. If you have any other kind of procedure while you have the gas bubble, let your doctor know, as the gas can react with other substances.

Your ophthalmologist may also want you to position yourself in a particular way throughout the day to allow the bubble to stay in contact with the back of the eye as much as possible. This is called ‘posturing’ and involves either lying on your front or sitting at an angle. It can be quite bothersome, but your specialist will give you some advice on how best to do this.

As with any kind of surgery, there are risks of complications, and your specialist will go through all of this with you. One of the most common complications after macular hole surgery is the development of cataracts (cloudiness in the eye’s natural lens). This usually happens the year after your macular hole surgery and can be treated with another operation.

Finally, if at any time after the operation you’re worried about additional symptoms, or if the eye becomes painful, get in touch with your ophthalmologist or go to your nearest eye casualty department.