Macular hole is a full thickness gap in the centre of the most central part of the eye called fovea. It usually presents with reduced vision or central distortion. Risk factors include old age, trauma, use of Tamoxifen and female gender. There are 4 stages of macular hole. The most useful test to detect macular hole is OCT. The above OCT scan shows a stage II full-thickness macular hole.
Macular holes are treated by vitrectomy surgery. In this surgery the surgeon removes the vitreous, peels a very delicate tissue called ILM and fills the eye with a gas bubble. The gas bubble stays in the eye for8-9 weeks. Most patients will be advised to posture face down after surgery. Depending on the size of the macular hole, this may vary from 24 hours to 7 days.
The anatomical success rate of macular hole surgery is more than 90%. Visual recovery depends on the duration of the hole. Hence, most patients of macular hole are operated fairly quickly, usually within a couple of days. Visual recovery continues for 3-6 months.
How long to I have to keep face down?
Dr Rehman Siddiqui mostly postures his patients face down for 24 hours only. Based on his published research click here cases with small macular hole size <400u do not require long face down posturing to improve macular hole closure.