If you do have a macular hole and you do not seek help, your central vision will gradually worsen. After a year, you will be unable to read even the largest print on an eye test chart.
There is evidence that relatively early treatment (within months) gives a better outcome in terms of improvement in vision.
There is a very small chance the hole may close and heal by itself, so for this reason your ophthalmologist may want to monitor its progression before recommending treatment.
If a macular hole is caused by vitreomacular traction, it may be possible to treat with an injection of ocriplasmin into the eye. The injection helps the vitreous jelly separate from the back of the eye and allows the macular hole to close. This treatment is successful at closing a macular hole in around 40 percent of cases.
The injection takes a few seconds and you will be given local anaesthetic as eye drops or an injection, so you will not feel any pain. You’ll also be given eye drops to dilate your pupil, so the ophthalmologist can see the back of your eye.
An ocriplasmin injection is usually only available in the early stages, while the macular hole is less than 400 micrometres wide, but causing severe symptoms.
You will not be able to drive after the injection as the eye drops cause your vision to be blurry. However, you should have normal, comfortable vision the day after.
If the ocriplasmin injection fails to close the macular hole, which happens in around 60 percent of cases, vitrectomy surgery will be needed to close the macular hole and improve your vision.
A macular hole can often be repaired using an operation called a ‘vitrectomy’, with inner limiting membrane (ILM) peel and gas.
A vitrectomy is a surgical treatment in which a doctor makes an incision in the eye and uses a small instrument to remove the gel and the blood that have accumulated in the vitreous as a result of retinal bleeding. The procedure is performed under local or general anaesthetic.
During the operation, the surgeon gently removes the vitreous gel, and releases the traction on the edges of the macular hole. Next, the surgeon injects a gas bubble inside of the eye. The purpose of the gas bubble is to place gentle pressure on the retina and help seal the hole.
Following the surgery, patients must remain in a face-down position during most of the day, and while sleeping at night. This routine will typically take several days to a week, but in some cases can take longer depending on the macular hole characteristics.
This position allows the gas bubble to press against the macular hole, helping it to seal. As the gas bubble is gently reabsorbed by the eye, the vitreous cavity refills with natural eye fluids. Maintaining a face-down position is crucial to the success of the procedure. Because this position can be difficult for some people, it is important to discuss this with your doctor prior to surgery.
It is a relatively quick procedure that should take no longer than one hour. Your eye may be mildly sore after the operation and will probably feel sensitive. In most cases you will be able to go home straight after surgery.
You must not fly or travel to high altitude on land while the gas bubble is still in your eye (up to twelve weeks after surgery). If you ignore this, the bubble will expand at altitude causing very high pressure inside your eye. This will result in severe pain and permanent loss of vision.
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Exeter Eye is a specialist ophthalmic eye clinic treating all eye conditions and offering the very best in patient care and comfort. We always ensure we fully understand your condition and lifestyle before identifying your treatment options and then help you choose the best one for you.