Macular Hole Surgery
Macular holes occur when a tiny break or opening forms in the macula, leading to distorted or blurred central vision. A macular hole is typically caused by excessive pulling of the vitreous gel, called traction, but a macular hole can also occur spontaneously or with blunt trauma to the eye.
Not every macular hole requires surgery right away. In rare cases, a small, early-stage hole may close on its own. But when vision becomes noticeably blurry or distorted, or when the hole continues to enlarge, surgery is usually the best option. Acting sooner rather than later improves the likelihood of a full recovery.
The standard treatment for a macular hole is a vitrectomy, a surgery in which the vitreous gel inside your eye is gently removed to relieve the pulling or traction that caused the hole to form.
What to Expect During a Macular Hole Surgery
Your surgeon may recommend internal limiting membrane (ILM) peeling to increase the chance of success to regain vision. ILM peeling may reduce the duration of face-down positioning required for macular hole closure. With ILM peeling, five or fewer days of face-down positioning may be adequate to effect hole closure. Peeling the ILM eliminates all tangential traction around the edges of the hole, the process believed to contribute to macular hole formation. It also ensures removal of any hyaloid remnants or epiretinal membranes that could otherwise be missed.
Pneumatic vitreolysis is when a gas bubble is injected into the eye in clinic then when the patient bends forward over and over the bubble rolls across the back of the eye attempting to break the connection between the gel and the retina, sometimes allowing the hole to close once that connection is broken. Pars plana vitrectomy is the most successful way of closing the hole but requires going to the operating room for surgery. Surgically the gel is removed from the eye, a layer called the internal limiting membrane of the retina is removed, and then the eye is filled with a gas bubble. That gas bubble helps push the hole closed. Gas bubbles dissolve away on their own over a period of 3 to 8 weeks. Sometimes your surgeon will ask you to maintain a face-down position to maximize the changes of surgical success.
Post Surgery
After surgery, you will need to keep your head in a face-down position for several days or weeks to keep the gas bubble in place. You will also be given eye drops to help lower the risk of infection and inflammation.
Follow-up visits are an important part of your recovery. During these visits, your retina specialist will monitor how the hole is healing, check the pressure inside your eye, and ensure that your vision continues to improve as expected. Vision typically improves within 4–6 weeks, with about 90% of patients experiencing successful closure of the macular hole after surgery. While full recovery can take several months, most patients notice steady progress and are able to return to many of their normal activities once the bubble fully dissolves.
Potential Risks
With any operative procedure there is always an uncommon underlying risk of complication. Risks may depend on your age, overall health, and specifics of your condition.
