Macular hole treatment
A macular hole causes a decrease in vision. Recovery without surgery is impossible. Make an appointment today with Dr. Pion, the retina surgeon at
Focus Eye Clinic.
Indication to surgery for a macular hole
A macular hole, an opening in the central part of the retina (the macula), has a poor prognosis if left untreated. Without medical intervention, vision will often gradually deteriorate, resulting in central vision loss and distorted vision. Spontaneous recovery of a macular hole is extremely rare and occurs only in a small number of cases. The decision to perform surgery depends on several factors:
1. The stage of the macular hole:
Stage classification plays an important role. From stage 2, where the hole begins to open and the edges become visible, surgery is usually indicated. At stages 3 and 4, where the hole becomes larger and the vitreous has detached further, surgical intervention is almost always necessary to prevent further damage to the retina.
2. Vision (visual acuity):
If the patient still has reasonably good vision, a wait-and-see attitude can be adopted, especially in the early stages. This depends on the degree of discomfort experienced by the patient and the rate of vision deterioration. If there is a significant decline in visual acuity, treatment is considered earlier.
3. The duration of the hole:
The longer the macular hole is present, the worse the chances of it closing after surgery. In addition, a longer-standing hole is more likely to cause permanent damage to the light-sensitive cells of the macula, limiting eventual visual recovery. Timely treatment increases the likelihood of successful closure of the hole and better vision.
4. Age:
Younger patients generally have a better chance of recovery than older patients.
5. General health:
Chronic conditions such as diabetes or hypertension can affect prognosis.
6. Patient discomfort:
The extent to which the macular hole affects daily life and functioning also plays a role in the decision to operate.
Conclusion: Timely diagnosis and treatment are crucial for preserving and restoring vision in macular hole. Surgical intervention, such as vitrectomy combined with the use of a gas bubble, often offers the best chance of closing the hole and improving vision. Without treatment, the prognosis is poor, while surgery can bring significant improvement in many cases, especially if performed early. The treatment plan is always tailored to the patient's individual situation.
From 2010 to 2023, Dr. Pion was head of eye surgery at St. Peter's Hospital in Brussels. During these 13 years, he took on the most complex surgical cases and led a team of more than 20 surgeons.
What is a vitrectomy
A vitrectomy is a surgical procedure performed to treat conditions in the vitreous and retina of the eye. The vitreous, a clear gel-like substance that fills the inside of the eye, is partially or completely removed during the procedure. This space is then filled with a special liquid, gas or silicone oil, depending on the type of treatment.
Vitrectomy is used for a variety of eye problems, including retinal detachment, macular surgery (such as an epiretinal membrane or macular hole), severe vitreous hemorrhage or infection, and complications of diabetes of the retina. Removing the vitreous allows the ophthalmologist better access to the retina to repair it or perform other treatments.
The procedure is usually performed under local anesthesia and takes an average of 20 to 60 minutes, depending on the complexity of the problem. Some recovery time may be required after surgery, depending on the filler used and the type of procedure. Vitrectomy is a safe and effective procedure that often leads to significantly improved vision or preservation of vision.
Personalized advice from our experts
Our highly specialized surgeons do a thorough diagnosis and analysis of your eyes. They will discuss all options with you in complete objectivity.
The course of a vitrectomy at Focus Eye Clinic
Step 1: Arrival and preparation at Focus Eye Clinic
Upon arrival at Focus Eye Clinic, you will receive a friendly welcome at the front desk, where our front desk assistants will register and prepare you for your surgery. Next, your pupil will be dilated (dilated) in preparation for the procedure. To make your experience as comfortable as possible, you will be given a relaxation pill. After all, surgery can be exciting, but our dedicated team of three nurses, two healthcare professionals, an anesthesiologist and Dr. Pion will guide you step by step.
Surgeries are always performed under local anesthesia, so you experience no pain and are completely at ease. This is always done under the supervision and guidance of our experienced anesthesiologist, who monitors your comfort and well-being throughout the procedure.
Step 2: Surgery of vitrectomy under local anesthesia (20 minutes - 1 hour)
The vitrectomy is performed under local anesthesia, so you will experience no pain and be completely at ease. The procedure itself takes an average of 20 minutes to 1 hour, depending on the complexity. During the surgery, the eye surgeon removes cloudy vitreous and replaces it with a clear liquid, which improves your vision.
Step 3: Get some rest before heading home
After the vitrectomy, you will be taken care of in our specially equipped relaxation area, where our dedicated nursing team will be there for you. Here you can rest peacefully and receive personalized care and attention. Our team will explain to you step-by-step instructions on postoperative treatment so that you are well prepared for your recovery at home. Once you are comfortable and have received all the information, you may safely leave for home. At Focus Eye Clinic, we strive to make your entire experience, from surgery to aftercare, as pleasant as possible.
How is a vitrectomy performed?
First step: inserting the trocards.
First, 3 separate openings will be made in the hard eye skirt (white sclera). The diameter of these openings is 0.57 mm. Three small tubes are placed in these openings through which the instruments enter the eye.
- At the first hole, the water drip will be placed.
- Through the second hole, the intraocular light will be inserted so that everything can be seen.
- Along the third hole, the vitrectome or intraocular forceps will be inserted into the eye.
Second step: removal of the vitreum
Through the vitrectome, the vitreum will be removed. The vitrectome is a small needle with a microscopic blade (guillotine) on the end. Small pieces of vitreum are aspirated into the vitrectome and cut off through the guillotine blade. Thus, the entire vitreum will be removed.
Third step: Manipulations on the retina
Depending on the condition, work will then be done on the retina. In a retinal detachment, the retina is brought back into place via special fluids. In membrane removals, a blue dye is introduced into the eye and then removed via ultra-fine tweezers. This stage is the most delicate step.
Fourth step: endolaser
To protect the retina from retinal detachment, an endolaser barrage will be performed at 360°. Studies have shown that this greatly reduces the risk of retinal detachment after vitrectomy.
Fifth step: insertion of the glass moisture substitute
Depending on your condition, the vitreous will be replaced with clear water, gas or silicone oil.
- If you eye is filled with gas, you will not see for 2 weeks. This gas may be necessary to keep your retina adjacent or to close a macular hole. However, it refers by itself. YOU MAY NOT TRAVEL BY AIRPLANE AS LONG AS THE GAS IS IN YOUR EYE.
- If your eye is filled with silicone oil you will have blurred vision. Silicone oil will be necessary if gas does not provide sufficient security of healing. Silicone will exert a stronger force on the retina to keep it in place. Silicone oil will always need to be removed with a new surgery.
Final step: closure of the eye
The final step is to close the eye by removing the
trocards. The openings are so small that they usually close by themselves. In
some cases, resorbable threads can be used. They
will disappear on their own after 4 to 6 weeks.
Prognosis of a macular hole
The prognosis of a macular hole depends on several factors, including the stage of the hole, the length of time it has been present, and treatment. Without treatment, a macular hole will usually lead to progressive deterioration of central vision, which can result in permanent visual impairment. Spontaneous recovery is extremely rare and occurs in only a small percentage of cases.
With timely surgical treatment, such as vitrectomy combined with gas injection, the prognosis is often favorable. The probability of successful closure of the hole after surgery is between 90-95% for holes that are present for a short time and are not too large. In these cases, vision may improve significantly, although it rarely returns completely to its original level.
However, the outcome becomes less predictable the longer the hole is present or when it is at an advanced stage. The longer the macular hole remains untreated, the greater the likelihood of permanent damage to the light-sensitive cells of the macula, which limits the eventual recovery of vision. With prolonged or larger holes, the probability of closure may drop to 50-60%, and vision improvement may be minimal.
Other factors affecting prognosis include the patient's age, general health status, and the speed with which treatment is initiated. Regular checkups and early intervention offer the best chance for a positive outcome. With successful closure, patients can expect central vision to improve and image distortions to decrease, although complete restoration of vision is rare.
Retinal surgeon: Dr. Bart Pion
Dr. Bart Pion, specialist in vitreoretinal surgery, is a leading retinal surgeon with years of experience in complex retinal surgery. He graduated magna cum laude from the Free University of Brussels in 2002, after which he specialized in retinal detachment, macular surgery and other advanced vitreoretinal procedures. Through continuous continuing education and participation in international conferences, he always stays abreast of the latest innovations in retinal surgery.
From 2010 to 2023, Dr. Pion was head of ophthalmic surgery at St. Peter's Hospital Brussels, where he spent 13 years performing the most complex eye surgeries and leading a team of more than 20 ophthalmic surgeons. During this time, he built a strong reputation in retinal surgery, cataract surgery and refractive treatments.
Here he performs vitrectomies, laser treatments and other innovative techniques to restore and protect his patients' vision. Focus Eye Clinic is the only extramural center in Belgium where retinal surgery is performed in an outpatient setting, offering patients fast and efficient treatment without hospitalization. His commitment to precision, innovation and the highest quality care makes him an authority in retinal surgery and vitreoretinal disorders.
35 years of expertise and confidence in eye care
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A team of experienced ophthalmologists for optimal care
With more than 2,000 surgeries per year and 35 years of experience, we have the expertise needed to give your eyes the best care.
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Investing in the latest technology for the best results
At Focus Eye Clinic, we combine expertise and innovation with state-of-the-art equipment in ophthalmology aimed at treating a variety of eye conditions. With technologies such as the Ziemer Z8 Femtolaser and WaveLight® EX500 excimer laser, we perform refractive treatments (including Femto-LASIK, PRK and SMILE) with unparalleled precision.
For cataract surgery, we use advanced systems such as the Zeiss CALLISTO, IOLMaster 700 and Alcon Centurion Vision System, resulting in highly accurate implant measurements and predictable results. In addition, we use the Heidelberg Spectralis HRA-OCT, Pentacam® HR and Nidek OPD-Scan III to comprehensively diagnose a variety of eye conditions.
In the treatment of dry eyes, we deploy LipiScan and LipiFlow, among others, for lasting relief of symptoms. Thanks to this innovative equipment, Focus Eye Clinic offers safe, efficient and personalized eye care of the highest quality - fully tailored to your individual needs.
Personal approach and customized care
At Focus Eye Clinic, your care is paramount. Our team of nurses, optometrists and assistants work together with one goal: improving your vision. From your first moment of contact to your final checkup, we will guide you with a personalized and caring approach.
A multidisciplinary team for your treatment:
Our experienced multidisciplinary team offers a wide range of ophthalmic treatments. After an initial diagnosis, we refer you to the doctor who best suits your specific needs, ensuring you receive the highest quality of care.
Your personal point of contact:
Throughout the entire procedure, a permanent assistant is available to you. She knows your file inside out and ensures that all your questions are answered quickly and clearly. If necessary, she will put you in direct contact with the right doctor.
Fast and efficient follow-up
We strive to offer you an appointment within two weeks and plan with you the most convenient time. This efficient system ensures a smooth and personalized experience, allowing you to concentrate fully on your treatment.
A luxurious and comfortable setting at Focus Eye Clinic
At Focus Eye Clinic, we believe that medical treatment should be not only effective, but also comfortable and soothing. Therefore, we have designed our clinic with an eye for luxury and comfort, so that you feel completely at ease from the very first moment.
Our modern and stylish spaces exude calm and confidence, and are designed to provide you with a relaxing experience. From the warm welcome at reception to the comfortable waiting areas and state-of-the-art treatment rooms, every detail has been carefully chosen with your well-being in mind.
At Focus Eye Clinic, we combine advanced technology with luxurious surroundings, so you can enjoy the highest quality care in a setting that exudes peace and confidence. Your health and comfort are our priority, and you will notice that with every visit.
