Macular Hole Surgery
A macular hole occurs when a small opening develops in the very centre of the retina, the part of the eye responsible for sharp, detailed vision.
The retina is a thin light-sensitive layer, lining the back of the eye, similar to the “sensor” of a modern camera. At its centre lies the macula, which provides your ability to read, recognise faces, see the colours and notice fine detail.
Most macular holes develop because the gel that fills the eye (the vitreous) pulls too firmly on the macula. We do not fully understand why that happens to some individuals, but abnormal adhesion of this gel is known to play an important role.
Macular holes can significantly affect vision. Common symptoms include blurred central vision and distortion, where objects may appear “pinched” or squeezed in the middle.
If left untreated, macular holes tend to enlarge with time and can cause permanent loss of central vision. Early diagnosis and timely treatment offer the best chance of closing the hole and protecting your sight.
Although the symptoms can feel worrying, macular holes are treatable, and with modern surgery most patients experience a meaningful improvement in their vision.
The main treatment for a macular hole is an operation called a vitrectomy. During this procedure your surgeon removes the gel inside the eye and gently peels the very thin surface layer of the retina, the internal retinal membrane (ILM). This releases the traction around the edges of the hole, and creates the conditions needed for it to close naturally.
At the end of the surgery a small gas bubble is placed inside the eye. This acts as internal support, helping the hole to seal and heal. Vision is blurred while the bubble is present, but it gradually dissolves over the following weeks.
In many patients macular hole surgery is combined with cataract surgery so both problems can be addressed at the same time. This means a single recovery period while reducing the likelihood of needing another operation soon afterwards.
Macular hole surgery is a highly successful operation. The majority of holes will close shortly after the procedure. Recovery is gradual, and vision normally continues to improve over several weeks.
While every eye is unique, most people regain clearer, more stable central vision, and experience significant improvement of distortion once the hole has healed.
If you’ve been diagnosed with a macular hole or are concerned about new distortion or blurred central vision, we are here to help you understand your options clearly and begin treatment at the right time.
From initial assessment to complete recovery, we will guide you through every step, from positioning advice to follow-up visits, ensuring your recovery is safe, supported and tailored to your needs.
Your questions answered
How successful is macular hole surgery?
It depends on the size, the stage of the hole, and other factors, but overall surgery for macular hole is very successful. Most holes close shortly after surgery and vision gradually improves.
Your surgeon will provide more information about the prognosis upon initial assessment.
Is surgery for macula hole painful?
The operation is not painful. Most surgeries are performed under local anaesthetic, but general anaesthetic options are also available. Any irritation or discomfort afterwards are usually mild and short-lived.
Will I need to posture after surgery?
Some patients may benefit from face-down posturing for a short period of time. Whether posturing is recommended depends on the size of the hole.
Your surgeon will give you personalised instructions about positioning after surgery.
How long will my vision be blurry?
Vision will be blurred while the gas bubble is present, and clears as the gas absorbs. Depending on the type of gas, this usually takes 2-4 weeks.
Can I fly after macular hole surgery?
You must not travel by air or to high altitude while the gas is present inside the eye, as pressure changes can be very dangerous. Your surgeon will confirm when it is safe to fly again.
How soon can I return to normal activities?
Most daily tasks can be resumed within days. Driving best to be avoided while gas is present inside the eye. Most people can return to office work after 1-2 weeks. Ask your surgeon about more specific tasks.
Will I need cataract surgery later?
Many patients will develop cataract after the vitrectomy, which is why cataract surgery is often performed at the same time to avoid a second operation.
What if the hole doesn't close?
This is uncommon. If the hole remains open, further treatment may be discussed, and options are individualised to the circumstances. Importantly, a hole that does not close after surgery does not usually lead to further visual deterioration.