The complications of macular hole can arise from the condition itself or from surgical treatment. Although a macular hole is not usually painful, it can have a major impact on central vision. This can affect daily activities, emotional wellbeing, and long-term vision outcomes.
If left untreated, a macular hole may worsen and lead to permanent central vision loss. Even after surgery, some patients experience lasting visual changes or side effects. Understanding these complications can help patients and caregivers manage expectations and plan ahead.
Progressive Vision Loss
One of the most serious complications of macular hole is progressive loss of central vision. When not treated in time:
- Small holes (Stage I) may expand into full-thickness holes.
- Central vision becomes increasingly blurred or dark.
- Reading, driving, or recognising faces becomes difficult.
Peripheral vision usually remains intact, but the central vision loss can become permanent, especially if the condition progresses for months without treatment. In advanced cases, scarring may prevent full visual recovery — even after successful surgery.
Macular Holes in Both Eyes
Although uncommon, macular holes can develop in both eyes. This happens in about 10–15% of cases. When both eyes are affected, it can:
- Severely limit vision
- Make independent living more difficult
- Affect work, driving, and daily tasks
If you’ve had a macular hole in one eye, regular monitoring of the other eye is important. Early detection can help prevent complications.
Complications from Macular Hole Surgery
Vitrectomy is a common and effective surgery to close a macular hole. But like any surgery, it carries some risks.
1. Cataract Formation
The most common complication after surgery.
- Seen in most patients over age 50
- Cataracts often develop within a year
- Can be treated with standard cataract surgery
2. Retinal Detachment
A rare but serious risk, affecting around 1–2% of patients.
- Caused by accidental tearing during surgery
- Requires urgent surgical repair to prevent vision loss
3. Persistent or Recurrent Hole
Sometimes the hole doesn’t close completely, or it reopens.
- More likely in large or long-standing holes
- May require a second surgery
4. High Eye Pressure (IOP)
Temporary rise in intraocular pressure can occur:
- Often linked to steroid eye drops
- Usually treated with medication and resolves on its own
5. Infection (Endophthalmitis)
A rare but vision-threatening infection.
- Symptoms: eye pain, redness, blurred vision
- Needs immediate treatment with antibiotics
Visual Changes After Surgery
Even if the surgery is successful, some patients continue to experience:
- Blurred or distorted vision
- Wavy lines (metamorphopsia)
- Trouble with reading or depth perception
- Difficulty seeing fine details
These symptoms may improve slowly over time. However, some distortions may remain. Vision therapy and low-vision aids can help patients adjust.
Emotional and Lifestyle Impacts
The complications of macular hole don’t just affect vision. They can also lead to emotional and psychological challenges, including:
- Anxiety about vision changes
- Depression due to reduced independence
- Frustration with post-surgery face-down positioning
- Difficulty maintaining social connections
Support from mental health professionals, occupational therapists, and low-vision support groups can make a big difference in quality of life.
Missed or Delayed Diagnosis
Missing the early signs of a macular hole can lead to worse outcomes:
- The hole may become larger
- Vision loss may become harder to reverse
- Surgery may be less successful
Routine eye exams are essential, especially for people with risk factors like myopia or vitreomacular traction. Tools like the Amsler grid can help catch changes early.
Risk in the Fellow Eye
Patients who’ve had a macular hole in one eye are at greater risk of developing one in the other. Monitoring both eyes regularly is important. Warning signs include:
- Visual distortion
- Blurred central vision
- Straight lines appearing wavy
Early treatment in the second eye can help prevent similar complications.
Summary
The complications of macular hole include progressive vision loss, surgical risks like cataracts or retinal detachment, and emotional challenges. Fortunately, modern surgical treatment is often very successful — especially when started early.
By understanding the potential complications and engaging in regular monitoring, patients can reduce their risk and protect their vision for the future.
