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Surgery is the only treatment for macular holes and is recommended when a macular hole extends all the way through the macula and/or has a major impact on vision and daily activities. Vitrectomy is the most effective surgical procedure to treat a macular hole and improve vision.

Vitrectomy

Vitrectomy is performed under local anesthesia. Your surgeon uses a microscope and tiny surgical instruments to perform the procedure. Three small incisions are made in the sclera (white outer wall of the eye) to access the vitreous. The procedure involves the removal of the vitreous gel that is pulling on the macula and removal of tissue (thin membranes) from the retinal surface around the macula. Peeling of the tissue helps closure of the hole by preventing anything from pulling further on the macula. A gas bubble is then instilled into the vitreous cavity.

Facedown positioning post-operation is the most important aspect of this surgery. The gas bubble rises and in the face-down position, the bubble is in contact with the macula and therefore exerts pressure on the macula where the hole is located. This stimulates hole closure and prevents any fluids within the eye from flowing through the hole and beneath the retina. The gas is gradually reabsorbed and is naturally replaced by the fluids. Facedown position is instructed up to a week, sometimes longer depending on your particular condition.

With newer surgical techniques and instrumentation, the surgery can be performed through tiny 'self-sealing' incisions without the need for sutures.

The success of the surgery depends on how well the face-down position is maintained. As the macular hole closes, the eye regains vision but the visual outcome is variable and depends on the size of the hole and for how long the hole was present before surgery.

Some of the complications of vitrectomy include infection, bleeding, retinal detachment, increased eye pressure and accelerated cataract formation. You must avoid flying until the gas bubble has dissolved, as higher altitudes can raise the eye pressure to dangerous levels.

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