Macular hole surgery in the UK

A macular hole is a small hole in the centre of the retina, and an operation called a vitrectomy is the only treatment that reliably closes it. Moorfields Eye Hospital puts the chance of closing most holes with one operation at around 90 to 95%, and over 70% of patients see better central vision afterwards. You may be asked to keep your head face down for a few days, and you can’t fly or drive until the gas bubble has gone.

What is a macular hole?

Moorfields Eye Hospital describes a macular hole as a small hole or tear in the centre of the macula, the part of the retina you use for reading and other tasks that need sharp sight. It stops the macula working normally, so the centre of your vision becomes blurred or foggy, straight lines and letters can look bent, and a dark or blind spot can appear as the hole gets bigger. Your side vision isn’t affected.

According to Moorfields, macular holes are more common in people over 60, twice as likely to affect women, and affect both eyes in about 1 in 10 cases. Most happen as the eye ages: the vitreous gel inside the eye shrinks and pulls away from the retina, and sometimes pulls hard enough on the macula to open a tiny hole. BEAVRS, the association for vitreoretinal surgeons in Britain and Ireland, says most holes appear between the ages of 60 and 80, often in people who are slightly long-sighted, and that a severe eye injury, high short sight, a previous retinal detachment or long-standing swelling of the central retina can also cause one.

A macular hole isn’t the same as age-related macular degeneration, although both affect the macula and BEAVRS says they can sometimes be present in the same eye. Epiretinal membrane and vitreomacular traction also affect the macula and are treated by vitreoretinal surgeons too. Our macular hole condition guide covers the condition itself.

Symptoms of a macular hole

• Blurred or foggy central vision, which makes reading and other close work harder
• Distortion: straight lines or letters look bent, wavy or crooked
• Missing letters when you read, especially small print
• A dark or blind spot in the centre of your vision as the hole gets bigger
• Normal side vision: the edges of what you see aren’t affected

A hole can also develop in the other eye. BEAVRS says your surgeon can assess that risk, which ranges from extremely unlikely to about 1 in 10, and that any change in the other eye’s vision should be reported to an eye specialist urgently.

Treatment options

Moorfields says an operation is the only way to treat a macular hole: eye drops, lasers and glasses won’t close it. A very small hole occasionally closes on its own or after an injection into the eye, but that isn’t common, and if your symptoms are mild and not affecting daily life, you might not need surgery straight away.

Without treatment, BEAVRS says about 1 in 10 macular holes close by themselves, with some improvement in sight. In most people, though, central vision slowly gets worse, until even the largest letters on a sight chart can’t be read. Because side vision is spared, a macular hole doesn’t cause total blindness.

Blue Fin Vision, the other clinic group we work with, offers consultant-led macular hole repair at its clinics in London, Hertfordshire and Essex, but doesn’t publish a price for it, so ask for a written quote. Prices and what they cover are on our macular hole surgery cost page.

What happens during the operation

The operation is a vitrectomy. Through three tiny openings, 1 to 2 mm across, in the white of the eye, the surgeon removes the vitreous gel, often peels the very thin internal limiting membrane from the retina around the hole to release the pull that keeps it open, and then fills the eye with a gas bubble. Moorfields describes the bubble as an internal splint that holds the edges of the hole together while it heals. In complex cases, BEAVRS says the membrane can be used to fill the hole.

1. Anaesthetic. Moorfields says most operations are done under local anaesthetic: an injection numbs the area around the eye, and you stay awake without feeling pain. You won’t see the details of what’s happening, though you may be aware of bright lights.
2. Vitrectomy. The surgeon makes three tiny openings in the white of the eye and removes the vitreous gel.
3. Membrane peel. The very thin internal limiting membrane around the hole is often peeled away to release the pull that keeps the hole open.
4. Gas bubble. The eye is filled with gas, which presses on the hole and holds its edges together while it heals.
5. Often home the same day. BEAVRS says the operation is often done as a day case. You can’t drive yourself home, so arrange a lift.

Moorfields says the operation usually takes 30 to 60 minutes and is most often done under local anaesthetic, so your eye is numb but you stay awake; general anaesthetic is rarely used. BEAVRS gives 45 to 90 minutes and says it is often done as a day case. If you have a general anaesthetic or sedation, Moorfields says someone must take you home and stay with you overnight, and you’ll be told when to stop eating and drinking beforehand.

How long the bubble stays depends on the gas your surgeon uses. Moorfields gives these typical times:

• SF6 (sulphur hexafluoride): usually 2 to 4 weeks
• C2F6 (perfluoroethane): usually 4 to 8 weeks
• C3F8 (perfluoropropane): usually 6 to 12 weeks

The vitreoretinal surgery guide covers the wider specialty, and macular hole surgery in London covers where to have the operation in the capital.

Recovery

Whether you need to keep your head face down afterwards depends on the size of the hole and your surgeon’s approach. BEAVRS says posturing improves the success rate for larger holes but may not be needed for smaller ones. When it is advised, Moorfields says it usually lasts 3 to 7 days, for 45 to 50 minutes of every hour during the day, with a 10 to 15-minute break each hour for meals, the toilet and gentle stretching (BEAVRS gives a usual range of 2 to 10 days). If you can’t posture, BEAVRS says there is still a good chance the hole will close.

Rules while the gas bubble is in your eye

• No flying or high altitude. Moorfields says you must not fly or travel to high altitudes while there is any gas bubble in your eye, because changes in air pressure make it expand, causing severe pain and possibly permanent damage. BEAVRS says this can mean up to 12 weeks.
• No driving. You must not drive while there is a gas bubble in your eye. Moorfields says your surgeon will tell you when it is safe to drive again, which can be several weeks or months.
• Tell any anaesthetist. If you need a general anaesthetic while gas is in your eye, BEAVRS says you must tell the anaesthetist, because some anaesthetic agents make the bubble expand too.

Results and risks

Moorfields puts the chance of closing most macular holes with one operation at around 90 to 95%, with better results for smaller holes and those that haven’t been there long. BEAVRS says about 90% close when the hole has been present for less than a year. Both say over 70% of patients see better central vision afterwards, often by two or three lines on a sight chart. Completely normal vision isn’t usually restored, and BEAVRS says treatment within months of the hole appearing tends to give a better improvement.

Your surgeon should talk the risks through with you before you agree to surgery. BEAVRS says harmful effects are unlikely, but in a small minority vision ends up worse than before. The main complications, with the figures Moorfields and BEAVRS give, are:

• The hole doesn’t close: about 5 to 10% after the first operation, more often with larger holes (Moorfields); BEAVRS gives 1 to 2 in 10. A further operation can often close it.
• Cataract: Moorfields says vitrectomy almost always speeds up cataract, especially over the age of 50, usually within 6 to 12 months. BEAVRS puts the chance at 4 in 5 if you haven’t already had cataract surgery.
• Retinal detachment: about 1 to 2 in 100 people, according to both Moorfields and BEAVRS, and it needs another operation.
• Infection inside the eye (endophthalmitis): very rare — about 1 in 2,000 cases according to Moorfields, or 1 in 1,000 according to BEAVRS — but it can cause severe loss of sight.
• Raised eye pressure: BEAVRS says this is quite common in the first days, usually because of the gas, and is normally controlled with extra drops or tablets.
• Worse vision than before: fewer than 1 in 50 people, according to Moorfields.

Cost, insurance and the NHS

• Private surgery. Sapphire Eye Care lists macular hole surgery from £7,000 per eye and vitrectomy with cataract surgery from £8,000. Sapphire Eye Care says its surgical prices cover pre-surgical assessments, the operation, hospital and facility fees, surgeon’s fees, anaesthetic costs and the follow-up care you need. Blue Fin Vision doesn’t publish a price. Our macular hole surgery cost guide has the details, including consultation prices.
• Insurance. Sapphire Eye Care says it is recognised by insurers including Aviva, AXA Health, Bupa, Cigna, Vitality and WPA. Whether your policy pays for macular hole surgery depends on its terms, so check with your insurer before you book, and ask Blue Fin Vision directly if you would like to be treated there.
• Paying. Payment terms are set by each clinic, so ask for them in writing before you book. Eye Surgery Clinic does not lend money or arrange finance.
• The NHS. Macular hole surgery is carried out on the NHS in hospital eye departments — Moorfields Eye Hospital NHS Foundation Trust, for example, publishes its own patient guide to the operation. Waiting times vary by hospital; our guide to NHS vitrectomy waiting times has more.

Frequently asked questions

Sources

• Moorfields Eye Hospital NHS Foundation Trust: Macular hole (NHS patient information)
• Moorfields Eye Hospital NHS Foundation Trust: Macular hole: diagnosis and treatment (review date September 2028)
• British and Eire Association of Vitreoretinal Surgeons (BEAVRS): Macular hole: patient information leaflet (2022 edition)
• Sapphire Eye Care: Our prices (prices from, per eye unless stated; read 17 September 2026)
• Blue Fin Vision: Vitreoretinal surgery (no published price for vitreoretinal surgery; read 17 September 2026)

We only publish the prices of the clinic groups we work with. General information, not personal medical advice: your eye specialist will tell you which treatment, if any, suits your eyes.