Is there any treatment for macular hole?
Rarely, your doctor might recommend not treating a macular hole if it is small, if it does not cause severe vision problems, and if the eye is otherwise healthy in all other ways. The doctor might just recommend that you have eye examinations more frequently to make sure that the macular hole does not get any larger or cause other problems. It is important to keep these appointments because although the macular hole might not get worse for a while, it will almost never go away by itself.
If your vision is decreased and the macular hole is small, your doctor may recommend the use of a drug or gas bubble that is injected into the eye. This treatment helps release the traction that caused the macular hole and allows the hole to close in certain cases. The injection is not painful as the eye is numbed before the injection is performed. Not everyone is a candidate for this form of treatment, so check with your doctor.
If your vision is decreased and the macular hole is not a candidate for an injection, then your doctor will recommend that the macular hole be treated with surgery.
What happens in the operation to treat a macular hole?
The surgical procedure for macular holes is performed under local anesthetic, so the patient is awake but does not feel the procedure.
The first part of the operation for macular hole treatment is to remove the gel-like fluid of the eye, which is called the vitreous. The procedure to remove it is called a vitrectomy.
The surgeon makes small openings in the eye to insert special instruments that are used to remove the vitreous. The surgeon may also remove any small pieces of tissue ("membranes") or traction near the macular hole using fine forceps. This is done to prevent anything from pulling on the macula preventing the hole from closing.
Finally, the fluid in the eye is exchanged with a sterile gas, which keeps pressure on the macular hole until it heals. Patients will need to maintain a face-down position for one to seven days to keep the gas bubble in place and help close the hole.