What is a macular hole?
The macula is the most important part of your retina – the part responsible for central vision. Sometimes, the gel which fills the eye can pull a hole in the middle of the macula. This is a macular hole, and it usually causes fairly sudden visual symptoms, normally described as blurring, reduction, distortion, or loss of central vision.

What happens if macular hole is not treated?
The hole will normally slowly enlarge over a year or so, and the corresponding missing ‘blob’ in the central vision may also therefore expand. Eventually, there is little useful central vision. The peripheral or navigational vision, however, is not usually threatened.

How can macular hole be treated?
The main treatment available is an operation known as vitrectomy.

This 66 year old lady was referred to Mr Shah with sudden reduction in vision in her left eye in June 2015. A, the OCT scan in June shows a full-thickness defect in the macula and this was associated with a profound reduction in central vision. B, Mr Shah performed a vitrectomy procedure to close the hole and this OCT scan shows the post-operative appearance with a closed hole. This patient's vision improved by over three lines on the testing charts following surgery.
This 66 year old lady was referred to Mr Shah with sudden reduction in vision in her left eye in June 2015.
A, the OCT scan in June shows a full-thickness defect in the macula and this was associated with a profound reduction in central vision.
B, Mr Shah performed a vitrectomy procedure to close the hole and this OCT scan shows the post-operative appearance with a closed hole. This patient’s vision improved by over three lines on the testing charts following surgery.

What happens after the surgery?
In macular hole, the eye is filled with gas at the end of surgery. Patients may be asked to posture face down for a day or two after surgery if the hole is felt to be large.

How successful is vitrectomy for macular hole?
The goal of surgery is to improve vision by closing the hole. The rate of hole closure after vitrectomy is over 90%, but the amount of vision which returns as a consequence of hole closure depends on the size and duration of the hole before surgery, as well as individual patient factors. Generally speaking, the sooner the operation happens after hole onset, the better the likely visual outcome of surgery. It is usually best if surgery can take place within 2-3 months of symptom onset; conversely, there is usually little visual benefit from surgery to holes which have been present for over a year.

Are there any alternatives to surgery for macular hole?
The only alternative treatment, which is for certain early or small holes only, is an injection called ocriplasmin. Mr Shah has published a clinical review article on this medicine – in summary, owing to safety concerns regarding this medicine, Mr Shah does not currently offer this treatment for any condition.