Macular hole surgery
Keyhole surgery to close a small gap in the centre of the retina (the macula) and improve distorted, blurred central vision.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Macular hole surgery closes a gap in the centre of the retina to improve central vision.
- It works best when the hole is treated early; long-standing holes are less likely to close and recover well.
- A gas bubble fills the eye afterwards, so vision is very poor for weeks and you must not fly until it has gone.
- Almost everyone develops a cataract within about a year, which can be treated with a separate routine operation.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Can close the hole and improve central vision
A very long-standing macular hole may close less reliably and recover less vision, so surgery needs careful discussion.
The eye is sore, red and watery and vision is very poor. You may be asked to keep your head face down or in a set position for much of the day for about a...
Clear, written posturing and no-fly instructions and help arranging any posturing equipment.
The eye is sore, red and watery and vision is very poor. You may be asked to keep your head face down or in a set...
You use eye drops and keep water out of the eye. Vision stays poor while the gas bubble fills much of the eye. Do...
The gas bubble shrinks and disappears, often seen as a wobbling line that drops down your vision. You must not fly...
Central vision continues to improve as the macula heals. A cataract usually develops in this period and may blur...
What is macular hole surgery?
The macula is the small central part of the retina that gives you sharp, detailed vision for reading and recognising faces. A macular hole is a tiny gap that opens in the middle of the macula, usually with age, causing blurred or distorted central vision and sometimes a dark or missing patch in the centre.
Surgery removes the jelly inside the eye (a vitrectomy), peels away a very thin membrane from the surface of the macula to release the pulling that holds the hole open, and fills the eye with a gas bubble. The bubble presses the edges of the hole flat so it can seal.
Surgery is good at closing the hole, especially when it is treated early, but it does not always restore vision fully, and it cannot undo damage from a hole that has been present for a long time. Two things are almost certain afterwards: very blurry vision until the gas absorbs, and a cataract developing within about a year.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Vitrectomy with membrane peel and gas
The standard operation: the jelly is removed, a very thin membrane (the inner limiting membrane) is peeled off around the hole, and a gas bubble is placed to hold the hole...
Face-down or set-position posturing
Holding your head face down or in a set position helps keep the gas bubble against the macula. It improves success for larger holes and may not be needed for small ones.
Different gas types
Surgeons use different gases that last for different lengths of time. The gas chosen affects how long your vision is poor and how long you must not fly.
Combined with cataract surgery
Because a cataract is so likely afterwards, some surgeons remove the lens and place an implant during the same operation, especially in older eyes.
Preparing for your surgery
- Ask how long your hole has been present, as earlier treatment generally gives a better chance of closure and recovery.
- Tell the team about all your medicines, including blood thinners, and any heart, lung or anaesthetic problems.
- Plan for poor vision in the operated eye for weeks, and arrange a lift home and help at home.
- Ask which gas will be used, how long it lasts, and how long you must not fly.
- Ask whether you will need face-down or set-position posturing, and for how long, so you can prepare practically.
- Sort out time off work, especially if your job needs sharp central vision.
What happens
The operation is done under local anaesthetic (often with sedation) or general anaesthetic and usually takes about an hour. The surgeon makes a few pinhole-sized openings in the white of the eye and removes the jelly.
Using very fine instruments, the surgeon peels a delicate membrane off the surface of the macula to take away the pulling that keeps the hole open. The eye is then filled with a gas bubble. The tiny openings usually seal themselves without stitches. Afterwards you may be asked to keep your head face down or in a particular position so the bubble presses on the macula.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A very long-standing macular hole may close less reliably and recover less vision, so surgery needs careful discussion.
- An eye with other serious disease may not benefit much from closing the hole.
- A patient who cannot manage the posturing or anaesthetic safely may need a modified plan.
- If central vision is only mildly affected, watching may be reasonable for a time.
Delay surgery if…
- There is an active eye infection or unstable medical problem making surgery unsafe for now.
- Essential air travel or altitude exposure is planned soon, as gas will be used — discuss timing.
- Important imaging of the macula (such as OCT) is still awaited.
- Blood-thinning medicines need review before surgery.
Alternatives to discuss
- Watchful waiting for a small, recent hole, though delay can reduce the chance of good recovery.
- An injection of a gas-releasing medicine (pneumatic vitreolysis) in selected small holes, where offered.
- No surgery if the hole is causing little trouble or the eye has limited potential.
- Low-vision support and aids if surgery is not chosen or not suitable.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Can close the hole and improve central vision
- Best chance of recovery when the hole is treated early
- Can reduce the distortion that makes straight lines look wavy
- Can stop the hole getting larger
- May improve reading vision over the months after surgery
Risks & complications
- Very poor vision for weeks while the gas bubble absorbs
- A red, sore, watery eye for the first weeks
- Developing a cataract within about a year
- Needing to hold a head or face-down position for several days
- The hole not closing, or reopening, and needing further surgery
- Raised pressure inside the eye
- A small permanent blind spot or change in side vision from the membrane peel
- A new tear or detachment of the retina
- Serious infection inside the eye (endophthalmitis)
- Bleeding inside the eye
- Significant loss of vision in the operated eye
The two near-certainties are weeks of very blurry vision from the gas bubble and a cataract forming within about a year. The main uncertainties are whether the hole will close (less likely if it has been present a long time) and how much central vision will recover. Ask your surgeon how long your hole has been there, the chance of closure for a hole your size, and whether your lens will be removed at the same time.
Published figures to discuss
How likely a hole is to close, and how much vision recovers, depend strongly on the size of the hole and how long it has been present. Published closure rates are averages from selected groups and should be read alongside your surgeon's view of your eye.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Hole closes with one operation | Around 9 in 10 for recent holes; published single-surgery closure rates are commonly about 90–93%, lower for large or long-standing holes | Closure does not guarantee full vision recovery; larger and older holes close less reliably. | Macular hole surgery using gas tamponade: Oslo study — PMCncbi.nlm.nih.govPublished figure |
| Cataract after surgery | Almost everyone, usually within about a year | Treatable with a routine separate cataract operation, sometimes combined. | Guide sourcesClinical context |
| Serious infection inside the eye (endophthalmitis) | Rare; modern vitrectomy meta-analyses report roughly 0.03–0.11% | Sudden pain, redness and loss of vision after surgery must be treated urgently. | Macular hole surgery using gas tamponade: Oslo study — PMCncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery is gradual. Vision in the operated eye is very poor at first because of the gas bubble, a bit like looking underwater, and improves only as the gas absorbs over a few weeks, with the macula continuing to settle over months.
- Very blurry vision, like looking through water, while the gas is present
- A red, gritty, watery or sore eye for the first weeks
- Seeing a wobbling bubble or line that drops as the gas absorbs
- Central vision improving only slowly over months
- A cataract clouding vision later, needing its own operation
Aftercare
- Use all prescribed eye drops exactly as directed to prevent infection and inflammation.
- Hold the face-down or set head position you are given to help the hole close.
- Do not fly or travel to high altitude while any gas bubble remains in the eye.
- Avoid heavy lifting, straining, swimming and rubbing the eye in the early weeks.
- Do not drive until the team confirms your vision meets the legal standard.
- Keep follow-up appointments so the hole and eye pressure can be checked.
- Know the warning signs that need urgent review and who to contact.
- Prescribed eye drops collected and understood
- Posturing instructions written down and equipment arranged if needed
- No-fly advice noted and travel plans checked
- Lift home and help for the first days arranged
- Time off work agreed with the team
- Emergency eye contact number saved
Scars and how they heal
There is no skin scar. The surgeon works through a few pinhole-sized openings in the white of the eye, which usually seal themselves without stitches. The eye looks red and may feel gritty while these tiny wounds heal.
⚠ Get urgent help if…
- Sudden worsening or loss of vision
- A new shadow, curtain, flashes or shower of floaters
- Increasing eye pain, especially with nausea or a hard, red eye (raised pressure)
- Increasing redness, swelling or discharge (possible infection)
- A severe headache or feeling very unwell after surgery with a gas bubble
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result is a hole that has closed, with central vision improving over the following months. Surgery is generally good at closing the hole when it is treated early — but closing the hole does not always mean vision returns to normal, and a long-standing hole may recover less.
Vision improves slowly as the gas absorbs and the macula heals, and a cataract forming afterwards can blur things until it is treated. Your surgeon should explain the realistic outlook for your hole, based partly on its size and how long it has been present.
Once a macular hole has closed it usually stays closed, although it can occasionally reopen and need more surgery. As you get older you keep the normal risk of other eye conditions, and the other eye has a small chance of developing a macular hole too, so ongoing eye checks are sensible.
Combining with other procedures
Macular hole surgery is often combined with, or followed by, cataract surgery because a cataract is so likely afterwards. The membrane peel that closes the hole is a routine part of the same operation.
Follow-up & long-term care
You will usually be reviewed within a week or two and then over the following months to check the hole has closed and the eye pressure is normal. Tell the team straight away about any sudden vision change, increasing pain or signs of infection.
- Cataract surgery later if vision clouds after the operation
- Monitoring of the other eye for a possible macular hole
- Regular eye checks for age-related changes
- Awareness of warning signs for the operated eye
- Further surgery only if a hole fails to close or reopens
Revision and secondary surgery reality
- A hole that does not close, or reopens, may need a further operation.
- Cataract surgery is very commonly needed afterwards if not done at the same time.
- Even after the hole closes, some distortion or reduced sharpness can remain.
- The other eye can develop a macular hole and need its own treatment.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Clear, written posturing and no-fly instructions and help arranging any posturing equipment.
- An urgent contact route and named team for sudden pain or vision change.
- Review to confirm the hole has closed and to check eye pressure.
- A plan for later cataract surgery once the eye has settled.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Surgeon's (vitreoretinal specialist) fee
- Anaesthetic and theatre or facility fees
- Type of gas used and any special instruments for the membrane peel
- Whether cataract surgery is combined or done separately
- Number of follow-up visits
- Any need for further surgery if the hole does not close
- The vitreoretinal surgeon's fee
- Theatre/facility and anaesthetic fees
- Cost of any gas or implants used
- Whether combined cataract surgery is included
- Number of follow-up appointments included
- What happens, and what it costs, if the hole does not close or a complication occurs
On the NHS? Macular hole surgery is commonly available on the NHS when clinically indicated; private care is used mainly for choice of surgeon, timing or second opinion.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Expecting vision to return to normal when a long-standing hole may recover only partly.
- Not being warned that vision is very poor for weeks while the gas is present.
- No clear explanation that gas means no flying and may mean face-down posturing.
- Not being told that a cataract will almost certainly develop afterwards.
Marketing red flags
- Promising full restoration of reading vision.
- Downplaying posturing, no-fly rules or the certainty of a later cataract.
- Not explaining that older, larger holes do less well.
- Presenting the surgery as without risks.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- How long has my macular hole been present, and how does that affect my outlook?
- What is the chance the hole will close for a hole my size?
- Will I need face-down posturing, and for how long?
- Which gas will you use, and how long must I not fly?
- Will you remove my cataract at the same time, or will I need that later?
- What symptoms should make me contact you urgently?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will surgery fully restore my central vision?
Why is my vision so poor straight after surgery?
Do I have to lie face down?
Why can't I fly afterwards?
Will I get a cataract?
Can the hole come back?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Macular hole Royal College of Ophthalmologists — patient information Cambridge University Hospitals — macular holes Macular hole surgery using gas tamponade: Oslo study — PMC Macular hole correction with and without face-down posturing (SF6) — PMC Macular hole surgery single-surgery closure rates — Mass Eye and Ear outcomes
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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