Macular hole surgery at Spire Little Aston Hospital

The macula is a highly sensitive area of the retina, in the eye, that is used for fine vision and reading. Symptoms of macular hole development include sudden drop in central vision making reading difficult and frequently distortion of straight lines and text.

The treatment of macular holes involves surgery. Recent advances in the technology of micro-instruments and optical viewing systems now allow consultants to perform surgery on the retina from within the eye.

This has resulted in the successful treatment of complex eye problems, such as macular holes, which were previously untreatable.

Our patients are at the heart of what we do and we want you to be in control of your care. To us, that means you can choose the consultant you want to see, and when you want. They'll be with you every step of the way.

All of our consultants are of the highest calibre and benefit from working in our modern, well-equipped hospitals.

Our consultants have high standards to meet, often holding specialist NHS posts and delivering expertise in complex sub-specialty surgeries. Many of our consultants have international reputations for their research in their specialised field.

You will have a formal consultation with a healthcare professional. During this time you will be able to explain your medical history, symptoms and raise any concerns that you might have.

We will also discuss with you whether any further diagnostic tests, such as scans or blood tests, are needed. Any additional costs will be discussed before further tests are carried out.

We've tried to make your experience with us as easy and relaxed as possible.

For more information on visiting hours, our food, what to pack if you're staying with us, parking and all those other important practicalities, please visit our patient information pages.

Our dedicated team will also give you tailored advice to follow in the run up to your visit.

The majority of macular hole surgery is performed as a day case under local anaesthetic, while general anaesthetic is still available for nervous patients.

If you are having general anaesthetic you should not eat or drink for six hours before the procedure. If having a local then light food and drink is allowed up to one hour before the procedure.

Before the operation we will speak to you and examine you on the ward. You will then be given eye drops to enlarge your pupils.

During your operation three needle-sized holes are made in the white of the eye allowing removal of the vitreous jelly.  This will allow the surgeon to repair the macular hole with delicate intraocular instruments which are used to remove any scar tissue holding the macular open.

The vitreous jelly will be replaced by a gas that will act as a support to hold the retina in position to help it heal. Your normal body fluids will replace the gas naturally over 3-4 weeks.

Quite often consultants will remove mild cataracts as part of the same procedure.

Small stitches are usually placed in the eye and at the end of the operation we will put a pad or bandage over your eye to protect it and reduce swelling.

Following the operation we will usually ask you to keep your head in a face down position for five days.  This is called 'posturing' and aims to provide support from the gas bubble to seal the macular hole.  Posturing cushions will be provided and you should ensure that someone is at home to help you for the first 5 days. You only need to posture for 50 minutes every hour during the day and can sleep in your normal position.

Most patients are able to leave hospital within a few hours of the procedure. If you have discomfort we suggest that you take a pain reliever, such as paracetamol every 4-6 hours. It is normal to feel itching, sticky eyelids and mild discomfort for a while after macular hole surgery and it common for your eye to water, while occasionally the area surrounding the eye can become bruised.

Most discomfort should ease after 2-3 days, while in most cases your eye will take about 6 weeks to heal. You will normally see the consultant in the clinic 2 weeks after your operation. Try to rest while your eye is healing.

Eyedrops will be given to help reduce any inflammation and to help prevent infection.

Certain symptoms could mean that you need prompt treatment.  Please contact the hospital immediately if you have any of the following symptoms:

• a lot of pain
• a loss of vision
• increasing redness in the eye
• a shadow developing in the vision

When you have a gas bubble in your eye you must not travel by aeroplane or ascend to significant altitude by other means of transport and must warn your doctor you have a gas bubble in your eye should you need another operation of any kind.

Macular hole surgery is not always successful. Every patient is different. Around 5% of patients may need more than one operation.

Most patients undergoing macular hole surgery usually develop a cataract in the operated eye over the following 6 months. Cataract surgery is a much less invasive procedure and can be carried out as a day case under local anaesthetic.

Please note that Spire Little Aston Hospital does not provide posturing cushions. We recommend you look into purchasing a posturing cushion to help you with your recovery - your nurse will recommend what you need.

We are committed to delivering excellent individual care and customer service across our network of hospitals, clinics and specialist care centres around the UK. Our dedicated and highly trained team aim to achieve consistently excellent results. For us it's more than just treating patients, it's about looking after people.

Important to note

The treatment described on this page may be adapted to meet your individual needs, so it's important to follow your healthcare professional's advice and raise any questions that you may have with them.