Macular Hole Surgery in Jacksonville, Florida
A macular hole is a small full-thickness gap in the very centre of the retina. It causes a blurred or missing spot in the middle of your vision, and it does not usually close on its own. Surgery closes it in the large majority of cases, and the sooner it is repaired the better the result.
What a macular hole is
The macula is the small central part of the retina responsible for reading, driving, and recognising faces. The fovea, at its very centre, is the thinnest and most specialised point in the entire retina.
As the vitreous gel separates from the retina with age, it can remain stuck to the fovea and pull on it. That traction stretches the tissue until it opens into a hole. Most macular holes are idiopathic — they happen to otherwise healthy eyes, most often in the sixties and seventies, and more often in women. Some follow blunt eye trauma or long-standing swelling.
Symptoms
- A blurred, grey, or missing spot in the centre of vision in one eye
- Straight lines bending or breaking — a door frame, a line of text
- Difficulty reading, particularly small print
- Words with letters missing from the middle
Peripheral vision is unaffected, so navigating a room stays normal. Because the other eye compensates, many people find it by chance when they happen to cover the good eye. Check each eye separately.
Diagnosis
A macular hole is diagnosed on optical coherence tomography, which shows the hole in cross-section and measures it in microns. That measurement matters: hole size is one of the strongest predictors of both closure and final vision, and it determines how we approach the repair.
OCT also distinguishes a true full-thickness hole from conditions that look similar and are managed completely differently — a lamellar hole, a pseudohole in an epiretinal membrane, or vitreomacular traction. More about our imaging and diagnostic testing.
Surgery
Dr. Elkeeb repairs macular holes with vitrectomy, internal limiting membrane peel, and gas.
The vitreous gel is removed through small incisions, relieving the traction that opened the hole. The internal limiting membrane — the transparent innermost layer of the retina, a few microns thick — is then peeled away in a circle around the hole, which removes the residual stiffness holding the edges apart and allows them to come together. The eye is filled with a gas bubble that supports the closing hole while it heals.
For unusually large holes, additional techniques such as an inverted ILM flap can improve the odds of closure, and we will tell you if your hole falls into that category.
Face-down positioning
We ask patients to position face-down for 72 hours after surgery.
It is worth explaining where that number comes from, because you will find contradictory claims about positioning online. The best available synthesis is an individual-participant-data meta-analysis of randomised trials, covering 379 eyes. It found a favourable effect on hole closure that did not reach statistical significance overall, a clearer benefit in holes 400 microns and larger, and — the finding behind the 72 hours — that additional days of positioning improved outcomes with the benefit appearing to plateau at about three days. The authors themselves graded the evidence as low certainty.
So: positioning is not proven to be essential, and it is not proven to be pointless. Three days is the best-supported single choice, and it is what we ask for. For a small hole we may modify it, and we will tell you why.
Practically, face-down positioning is the hardest part of this operation for most patients. Positioning equipment can be rented — a face-down chair, a table-top support, a mirror that lets you watch television. Arrange it before surgery, not after.
What the results look like
Realistic expectations here matter more than reassurance.
Closure. The hole closes with a single operation in roughly 90 to 95 percent of typical cases. Very large holes do less well — below about 65 to 80 percent once the hole exceeds 650 to 800 microns.
Vision. Most patients gain vision, commonly two to three lines. But average acuity after a successfully closed hole sits in the 20/60 to 20/70 range rather than 20/20. Some blur or distortion in the very centre often remains.
Duration matters. Every additional month a hole has been present slightly lowers the odds of closure and costs roughly one letter of final acuity per two months — independent of how big the hole is. This is the single strongest argument against waiting.
Recovery
- The gas bubble. Vision through it is very poor — a dark, wobbling line that descends as the bubble absorbs over two to eight weeks depending on the gas.
- No flying and no high altitude while gas is in the eye. Altitude expands the bubble and can raise pressure in the eye dangerously.
- Cataract. If you still have your natural lens, expect cataract to progress. Roughly half to two thirds of patients over 50 need cataract surgery within one to two years of vitrectomy.
- Vision improves slowly. Most gains come over three to six months, with slower improvement continuing for up to a year.
The other eye
The risk of a macular hole developing in the fellow eye is real but modest, and it is higher if the vitreous has not yet separated in that eye — something we can see on OCT. We check it and follow it, and we will tell you what your own scan shows.
Questions patients ask
Will a macular hole heal on its own?
Occasionally a very small, very early hole closes spontaneously, but this is uncommon and not something to plan around. Waiting reduces the chance of closure and the final vision.
How long can I wait before surgery?
This is not a same-day emergency the way a retinal detachment is, but it is not something to defer for months either. Outcomes decline measurably with duration. Weeks, not seasons.
Do I really have to lie face down?
We ask for 72 hours. The evidence supporting it is real but not conclusive, and the benefit is clearest for larger holes. We would rather say that than pretend the science is settled, and we would still rather you did it.
Will my vision go back to normal?
Usually not entirely. Most patients gain two to three lines and the missing central spot fills in, but some distortion or softness in the very centre commonly persists. A closed hole with imperfect vision is a good outcome.
Can I have a macular hole in both eyes?
It is possible but most people do not. We examine and scan the fellow eye and follow it.
Getting seen
We accept urgent referrals and see urgent cases within 24 hours. Call (904) 666-5050. Our office is open 8:00 am to 5:00 pm, Monday to Friday, at 3627 University Blvd S, Suite 605, Jacksonville, FL 32216. Our staff speak English, Arabic, and French.
Dr. Elkeeb operates at HCA Florida Memorial Hospital and Baptist Medical Center Jacksonville.
Referring physicians and optometrists: our referral information is here.
Sources: Face-down positioning in macular hole surgery, systematic review and individual participant data meta-analysis, Ophthalmology 2025;132:194–205; effect of macular hole duration on surgical outcomes, individual participant data analysis of randomised trials, Ophthalmology 2023; outcomes in large macular holes, Eye 2024; contemporary macular hole surgery series, Eye 2026; cataract progression after lens-sparing vitrectomy, Scientific Reports 2022.
This page is general information about a medical condition and is not a substitute for examination and advice from your own physician. Do not start, stop, or change any medication based on what you read here.