Having surgery

You should have received our information about having surgery, which gives more information about what to bring with you and what to expect during your visit. If you do not have a copy, please ask a member of staff for one. 

You will also have a pre-operative assessment with a nurse where more information will be provided. 

Preparing for surgery

Changes to your medicines 

You might need to stop taking some of your medicines before the surgery. 

Do not make any changes to your usual medicines, and continue to take them, unless you have been told otherwise.

Bring any medicines you are currently taking with you. 

You should let us know if: 

• you are taking any blood-thinning medicines, such as antiplatelet medicines (for example aspirin or clopidogrel) or anticoagulant medicines (for example warfarin or rivaroxaban),as you might need to stop them temporarily before your surgery
• you have diabetes, as you might need to change the dose of your diabetes medicines
• you are taking any regular medicines (including anything you buy from a pharmacy or shop, and any herbal or homeopathic medicines)
• you have any allergies to any medicines

More information on stopping any medicines will be given to you at your pre-assessment appointment. 

Fasting (not eating or drinking) instructions 

Do not eat or drink anything (except non-fizzy water) for 6 hours before your appointment. This means that you cannot suck on sweets or chew gum.

You are allowed to drink water up to 2 hours before your appointment.

If you continue to eat or drink after this, your surgery will be cancelled.

During surgery

Macular hole surgery is sometimes done under a general anaesthetic (medicine that causes you to be asleep for the entire procedure).  Other times it is done under a local anaesthetic which ‘freezes’ the area around your eye so that it is pain-free, but you are awake. Your surgeon will discuss with you the type of anaesthetic that is being recommended.

An anaesthetist (specialist in anaesthetics), will meet with you and discuss the anaesthetic you will have. If you have a general anaesthetic, they will stay with you and monitor your care during surgery.

You can read our information about having an anaesthetic. 

Using delicate instruments, the surgeon will remove the ‘jelly’ in your eye. They will take particular care to peel the jelly away from your retina at the back of your eye. This leaves a space inside the eye which we put gas in.

The gas is inserted to help the macular hole heal in the correct place. This gas is lighter than air so it floats upwards. The gas acts like a bandage. It presses the macular hole flat onto the back of your eye, repairing the hole and making sure that there is no risk of further damage or retinal detachment.

In the 7 to 10 days after surgery, the gas bubble slowly shrinks and eventually disappears. As this happens the space that was taken up by the gas is filled with aqueous fluid (the natural fluid made by the eye). With the gas in place, the vision in your eye will be very poor, a bit like having your eye open under water. When the gas has been absorbed, your vision should improve. This generally takes 6 to 8 weeks.

If you have other problems with your eyes, such as cataracts, it is possible, and quite common, for these to be treated during the same operation. Your surgeon will give you more information, and you might want to ask for our information on the other conditions that are being treated.

After surgery

After surgery your eye might be sore. When you wake up, your eye will be padded with a plastic protective shield taped over it. The pad and shield can be removed the day after the operation.

You will have some vision in the eye which was operated on. It is very hard to predict how much, because it depends on lots of different things. Before your surgery your eye surgeon will talk to you about what to expect.

Leaving hospital

You will usually need to stay in the hospital overnight, so the doctors and nurses can monitor your recovery and make sure you are well enough to go home.

If you had a general anaesthetic, you will not be able to leave the hospital unless a responsible adult is there to help you get home.

You will be given information about going home after eye surgery, which has details about looking after yourself until you have fully recovered from the anaesthetic. It is very important that you follow these instructions.

Caring for your eye after surgery

Eye drops

We will give you eye drops to take home. It is important that you use these as directed. One is usually a steroid to control the inflammation, that you will need to use 4 times a day for a month. The other is an antibiotic to prevent infection, and you will use this 4 times a day for 2 weeks. You might also be given drops or tablets to control the pressure in your eye. We will review this treatment at your follow up appointment about 2 weeks after your operation.

Sleeping positions

You will need to sleep with your head on one side, resting on an ear. You must not sleep on your back for at least 1 month after your operation. This is to make sure that the gas bubble is in contact with the macular hole as much as possible.

If you cannot lie on your side, you should sleep propped up with pillows so that you are at a 45 degree angle. If you move around a lot at night, some people have found it useful to sew a clothes peg onto the back of their nightclothes. This can stop you from moving onto your back while you are asleep. We can give you more information about this.

If you have concerns about sleeping positions, please talk to your doctor or nurse.

Posturing 

As well as keeping your head in a certain position overnight, it might be necessary for you to spend several hours during the day with your head held still and in a specific position. This is called posturing. It will depend on your specific condition and the professional opinion of your surgeon. Some people will not need to do posturing at all.

If you need to posture after your operation, your surgeon and nurse will have explained this to you, and given you written instructions to take home.

Returning to normal activities

The gas bubble will still be in your eye for 6 to 8 weeks after your surgery.

During this time:

• you must not drive a motor vehicle of any sort
• you must not fly in an aeroplane

If you need to have a general anaesthetic for any reason during this time, you must tell your doctor and anaesthetist that you have recently had macular hole surgery, and that you might still have a gas bubble in your eye.

After surgery the gas bubble will give you very poor vision in that eye. This means that your balance will be affected and you will have trouble judging distances. You will have to be very aware of steps and kerbs.

It's not safe to operate machinery or to use tools which could be dangerous. You should also expect to have some problems with activities such as pouring liquids or picking up objects.

Your vision should become more normal when the gas bubble has gone. Most people are aware of when the gas bubble has gone. You will be able to see it getting gradually smaller. It usually takes 6 to 8 weeks.

Follow-up appointment

You will be given an appointment to return to the hospital 1 to 3 weeks after the operation. This is to check that the macular hole is healing. We will often change the eye drops that you are using as well.

If you do not receive an appointment, or need to change it for any reason, please contact the eye department’s reception, phone: 020 7188 4311

When to get help

Your eye will feel sensitive and might be uncomfortable after the operation.