Medically reviewed by Dr. Niranjana Bejan Singh. Written to established clinical-education standards (AAO/Mayo/NHS/NEI) and adapted for this hospital. Not a substitute for professional medical advice.
A macular hole is a small break that forms in the macula, the central part of the retina responsible for the sharp, detailed vision needed for reading and recognizing faces. It commonly develops when the vitreous gel inside the eye shrinks with age and pulls away from the retina, tugging on the macula until a hole forms. Macular hole surgery — a form of vitrectomy — removes the vitreous gel causing the traction and places a gas bubble to help the hole close as the retina heals.
Who typically needs this
- Recommended for patients with a symptomatic macular hole causing blurred or distorted central vision.
- More urgent for larger holes or holes present for a shorter duration, since earlier treatment tends to give better visual results.
- Considered once a macular hole is confirmed on retinal imaging, typically optical coherence tomography (OCT).
- Not usually recommended for very early or very small holes, which may sometimes be observed first at the retina specialist's judgment.
What to expect
- Performed as a vitrectomy, usually under local anesthesia with sedation.
- The vitreous gel is removed through tiny incisions in the sclera.
- A thin membrane on the retina's surface (the internal limiting membrane) is often gently peeled to relieve remaining traction and help the hole close.
- A gas bubble is placed inside the eye to act as an internal "splint" holding the edges of the hole together while it heals.
Recovery
- Face-down positioning for part of each day, for several days to about a week, is typically required to keep the gas bubble in contact with the macula.
- Vision remains blurred or blocked while the gas bubble is present, gradually clearing as it absorbs over several weeks.
- Air travel and high-altitude travel must be avoided until the gas bubble is fully gone.
- Full visual improvement can take weeks to a few months, and reading vision often continues to improve gradually.
Risks to know about
- The hole may not close completely with the first surgery, occasionally requiring a second procedure.
- Cataract progression is common after vitrectomy and may require future cataract surgery.
- Elevated eye pressure, infection, retinal detachment, or a visual field defect from membrane peeling are recognized but less common risks.
- Positioning requirements can be physically demanding for some patients, particularly the elderly or those with neck or back problems.
Frequently asked questions
Do I really need to stay face-down after surgery?
Yes, in most cases — keeping the gas bubble in contact with the macula significantly improves the chance the hole closes properly. Your surgeon will confirm exactly how long and how strictly.
How much vision will I get back?
Many patients regain meaningful improvement in central vision, but the amount depends on the hole's size and how long it was present before surgery.
Can a macular hole close without surgery?
Very small, early holes are occasionally observed, but most macular holes that cause symptoms need surgery to close, since they rarely seal on their own.
How soon can I fly after surgery?
Not until your surgeon confirms the gas bubble has fully absorbed, which can take several weeks depending on the gas used.
Ready to see us?
Call the appointment desk, or book online — we will confirm your time by phone.
Sources consulted: AAO — What Is a Macular Hole?, Mayo Clinic — Vitrectomy . General medical information — not a substitute for professional diagnosis. Medically reviewed by Dr. Niranjana Bejan Singh.
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