During vitrectomy, your eye surgeon replaces the vitreous gel with a bubble that acts as a temporary bandage to hold the edge of the macular hole in place as it heals.

Treatment of a Macular Hole

Although some macular holes can seal themselves and require no treatment, many patients with a macular hole will require surgery to help improve their vision. In this surgical procedure called a vitrectomy, your eye surgeon removes the vitreous gel to prevent it from pulling on the retina and replaces that gel with a gas bubble. The bubble acts as an internal temporary bandage that holds in place the edge of the macular hole as it heals. Vitrectomy surgery is usually performed on an out-patient basis and most patients receive local anesthesia.

Recovery from Macular Hole surgery

Patients can find recuperating from macular hole surgery a challenge, as they must remain in a face-down position—usually for a day or two, but sometimes for as long as two to three weeks. Maintaining this position is critical to the success of the surgery, as it allows the bubble to press against the macula and gradually be resorbed by the eye, sealing the hole. As the bubble is resorbed, the vitreous cavity refills with natural eye fluids. A number of devices can make the "face-down" recovery period easier to tolerate, and some recovery approaches can decrease the amount of "face-down" time you require. Discuss these with your eye surgeon.

Does Macular Hole surgery present any risks?

The most common risk following macular hole surgery is an increase in the rate of cataract development. In most patients, a cataract can progress rapidly, and often becomes severe enough to require removal. Other less common complications include infection and retinal detachment, either during or after surgery. Your eye surgeon can treat both of these complications immediately.

If you have a gas bubble, air travel presents a serious risk until the gas bubble has dissolved; the rapid increase in altitude can cause a dangerous rise in eye pressure. Nitrous gas used in general anesthesia also poses a risk to patients with a bubble, though general anesthesia without nitrous gas is usually considered safe.

Is this surgery generally successful?

The degree of vision improvement after surgery varies from patient to patient. Patients who have had a macular hole less than six months have a better chance of improved sight than those who have had one for a longer period of time. It is important to realize that results might not be immediate: vision recovery can continue for as long as three months after surgery. Before surgery, discuss your expectations for vision recovery with your doctor.