Surgery for Macular Holes

Macular Hole Caused by Vitreous Shrinkage And/or Separation

The back of your eye is filled with a rather thick, gel-like material called the vitreous humour (also called the vitreous body or the vitreous) that helps your eye keep its shape. The clear vitreous shrinks and becomes more liquid with aging, causing it to slosh around.

Because the vitreous is attached to the retina with tiny strands of cells, it can pull on the retina as it shrinks. Sometimes, this shrinkage can tear off a small piece of the retina, causing a hole. If this missing piece of retina is in the macula, it’s called a macular hole.

Macular Hole Surgery and Repair

A vitrectomy is the most common treatment for macular holes. In this surgery, a retinal specialist removes the vitreous gel to stop it from pulling on the retina. Then the specialist inserts a mixture of air and gas into the space once occupied by the vitreous.

This bubble of air and gas puts pressure on the edges of the macular hole, allowing it to heal.

While the bubble is doing its job, you must lie face down so that the bubble stays in the right place in the eye, sometimes for as long as two to three weeks! Although it can be very boring and obnoxious to stay still for so long, this approach is absolutely necessary for you to achieve the best vision after treatment.

The gas/air bubble gradually goes away over time, and natural eye fluids take its place while the hole is healing.

Risks of vitreous surgery include infection and retinal detachment, both which are treatable. The most common risk, however, is cataract development. Cataracts usually occur rather quickly after a vitrectomy, but they can be removed once the eye has healed.

If you have had surgery for a macular hole using a gas bubble, you won’t be able to travel by air for several months, because the gas can expand with pressure changes, causing eye damage.

People who have had a macular hole in one eye have a higher chance (about 10 percent) of developing a macular hole in their other eye at some time in their life. Therefore, you should have regular eye exams as determined by your eye doctor to catch problems early.