advanced ophthalmology

What is a macular hole?

The macula is the part of the retina with the greatest visual acuity, i.e., it is the area where the image lands when we look at an object and is therefore what enables us to appreciate our surroundings with maximum clarity.

A macular hole, as the name indicates, is a gap in the macula. Depending on the length of time over which it develops, it can be either complete or incomplete.

Symptoms of a macular hole

Depending on the length of time over which it progresses, the symptoms can be more or less intense and include the following:

Reduction in visual acuity

with perhaps a black spot even appearing in the central area of vision (scotoma).

Distortion of objects

or seeing straight lines as wavy (metamorphopsia).


The main cause behind a macular hole is traction of the vitreous (the gel that gives the eye its shape) on the retina (the innermost layer of the eyeball), which stretches it and leads to the formation of a hole. Other causes include acute or chronic inflammatory processes and eye injuries.


Al ser generalmente una patología con tendencia a la progresión, el objetivo principal del tratamiento es frenar su avance a la vez que se intenta recuperar la máxima agudeza visual posible, lo cual dependerá del estado de base de la retina y del tiempo de evolución del agujero.


Surgery is performed, consisting of a vitrectomy with internal limiting membrane peeling (the innermost layer of the retina) to encourage the hole to close. Gas is then inserted inside the eyeball to settle the changes made during the surgical procedure. There are currently some new methods emerging that can accompany the habitual surgery described to encourage regeneration of the damaged retinal tissue, such as the use of plasma rich in growth factors.


At CLÍNICA RAHHAL, we have state-of-the-art technological equipment which, combined with our teamwork, ensures the best results.

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“I have been going to Rahhal for many years with my entire family because of the quality of the service and the family-friendly atmosphere that the whole team provides”.

Fernando Alcañiz.

“Besides his professionalism, you can see that Dr Rahhal enjoys his work and is happy doing it. I went to him for an initial consultation and have never thought about going to another clinic. I am truly delighted”.

Lourdes García. 

“I have been a patient for some time and I am delighted with them. The staff are attentive and very professional, and the facilities are excellent. Highly recommended!”

Esther Herranz. 



At CLÍNICA RAHHAL, we don’t want you to have to break the bank to be able to see; we want to ensure our patients can afford our treatments.

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Select one of the following frequently-asked questions from our patients to show the answer. If you cannot find the answer to your question, please contact us using the form below.

Is a macular hole the same as a detached retina?

No, although they can sometimes be linked. Even though they both relate to the retina, what happens with a macular hole is that there is a discontinuity of the layers of the retina, whereas with a detached retina, its original position is “lifted”.

Is there any non-surgical treatment?

Currently, the only treatment available is surgery to perform a vitrectomy and internal limiting membrane peeling, although there are some variations as regards the techniques adopted according to each case.

Is it dangerous to leave it without operating?

A macular hole typically tends to progress over time and the more advanced it is, the more difficult it will be to recover vision despite performing surgery. The speed of its progression will depend on each individual case, so the surgical option must be discussed between the patient and the surgeon attending to the vision loss that the patient is describing and the findings in the eye examination as well as the speed of its development.

Will I be able to see again properly if I have the surgery?

Surgery for a macular hole is a delicate surgery in which we try to get the retina to return to its normal anatomy or shape. However, this does not always translate to a clear vision improvement. In many cases, the patient’s vision is completely restored, although in other cases some symptoms persist, such as metamorphopsia (seeing distorted outlines) and we do not fully recover vision. This will depend on the cause of the macular hole and the length of time it has been progressing, as let’s not forget that the retina is a tissue made up of nerve cells.

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