Macular hole surgery is a keyhole vitrectomy that closes a small full-thickness gap in the centre of the retina. The surgeon removes the vitreous gel, peels the fine internal limiting membrane (ILM) from the macula and fills the eye with a gas bubble, which holds the edges of the hole together while it seals. Closure is achieved in 92–95% of cases, with vision improving over the following months. Private self-pay fees start from £6,500 per eye (vitrectomy + ILM peel + gas), all-inclusive of consultant, theatre and follow-up. Face-down posturing after surgery improves closure.
What is a macular hole?
The macula is the small central part of the retina responsible for your sharpest, straight-ahead vision — reading, faces and fine detail. A macular hole is a full-thickness gap that opens in this central tissue. As it forms, central vision becomes blurred and distorted: straight lines look bent or wavy, and a grey or blank patch appears in the middle of the view while the peripheral vision stays normal.
Most macular holes are idiopathic and age-related, caused by the vitreous gel tugging on the macula as it separates from the retina (vitreomacular traction). They are more common after age 60 and in women, and occasionally follow injury or high short-sightedness. They are closely related to epiretinal membrane and vitreomacular traction. Read more on our macular hole condition page.
Symptoms of a macular hole
- Blurred central vision — difficulty reading or recognising faces
- Distortion (metamorphopsia) — straight lines appear wavy or bent
- A grey or dark spot in the centre of vision
- Reduced ability to see fine detail in the affected eye
- Peripheral (side) vision remains unaffected
Wavy lines or a central blur? An OCT scan shows a macular hole in seconds and stages it precisely. Earlier repair of a smaller hole gives the best visual recovery.
Book a macular assessmentTreatment options
Surgery is the only reliable way to close a full-thickness macular hole. The technique is tailored to the size and stage of the hole, and whether you also have a cataract.
All macular-hole repairs are performed by our vitreoretinal surgery team. You can also read the full surgical detail on our macular hole vitrectomy page.
What happens during surgery
Macular hole surgery is a day-case keyhole vitrectomy performed under local or general anaesthetic, usually taking 45–60 minutes:
- Anaesthetic is given and three tiny ports are made in the white of the eye (pars plana).
- A vitrectomy removes the vitreous gel and relieves the traction pulling on the macula.
- The surgeon gently peels the internal limiting membrane (ILM) around the hole using a dye to make it visible.
- The eye is filled with a gas bubble that presses the edges of the hole together (tamponade).
- You posture face-down as instructed so the bubble holds the macula while the hole seals.
Recovery week-by-week
Vision is dark and blurred at first because of the gas bubble, then improves steadily as it absorbs and the hole heals.
First few days
Face-down or set-position posturing as instructed. The eye is gritty and vision is dark from the bubble. Use prescribed drops.
Weeks 1–2
First review and OCT confirm the hole is closing. The gas bubble shrinks; you may see a wobbling line as it absorbs.
Weeks 2–8
Gas fully absorbs and the lower field clears first. No flying while gas remains. Central vision begins to sharpen.
Months 2–6
Vision continues to improve and distortion settles. A cataract often develops over time and can be treated later if not done at the same operation.
Important: while a gas bubble is in the eye you must not fly or have nitrous-oxide anaesthesia until your surgeon confirms it has fully absorbed.
Cost & insurance
Our macular hole surgery fees are all-inclusive of the consultant, theatre, anaesthetic, gas and a structured follow-up:
- Vitrectomy + ILM peel + gas: from £6,500 per eye.
- Inverted ILM flap (large holes): £7,500–£10,500 per eye.
- Phacovitrectomy (with cataract): £8,500–£11,500 per eye.
- Insurance: recognised by Bupa, AXA, Aviva, Vitality, Cigna and WPA — macular hole repair is functional and usually covered. We handle authorisation.
- Finance: 0% options available to spread the cost.