The Retina is like a photographic film that lines the back of the eye. The Macula is the centre portion of the retina, which is closely attached to the vitreous gel. As the vitreous gel shrinks with age (See Posterior Vitreous Detachment), the vitreous can start to pull on the retina. In some patients, the vitreous can be unusually sticky in the macular region and as it shrinks away from the retina, it can pull a small hole in the macula. This can lead to significant loss of central vision, which if left too long can become permanent.
I usually treat macular holes with an operation known as a Vitrectomy. I can combine this with Cataract Surgery.
During vitrectomy, I insert very fine instruments through the white of your eye, into the back of the eye and I slowly cut and suck away the vitreous jelly.
In most cases of macular hole, the inner lining of the retina known as the Internal Limiting Membrane (ILM) can be quite stiff and splint the hole open. For this reason, I remove the ILM during the surgery.
After the vitreous and ILM are removed, I search the retina for any other problems and I can treat those too. Once this is all done, I replace the vitreous jelly with a gas bubble. This bubble helps the macular hole to close up.
After the operation, I may ask you to position your head looking down towards the floor (posturing) for 3 days after the surgery. This often helps bigger holes to close. Smaller holes, often close without posturing, so I do not ask all patients to posture. I will discuss this with you in detail, depending on your eye.
Outcomes of Macular Hole Surgery
Overall, about 9 out of 10 of macular holes will close with one operation, so it is unusual to have to repeat surgery. My macular hole closure rate is in excess of 95%.
In nearly all patientshaving macular hole surgery, vision will be stabilized and any further loss of vision is prevented, so surgery is worthwhile. Approximately 7 out of 10 patients will have at least 2 lines of vision improvement on the vision test charts.