Macular Hole: Symptoms, OCT Diagnosis, Surgery and Visual Recovery

Author: Dr Val Phua
Estimated reading time: 11–13 minutes

Why Is There a Missing or Distorted Spot in the Centre of My Vision?

A macular hole is a small opening that develops in the macula—the central part of the retina responsible for sharp, detailed vision.

It may cause:

• Blurred central vision
• Straight lines appearing bent or wavy
• A small grey, dark or missing central spot
• Letters disappearing while reading
• Difficulty recognising faces
• Reduced detail when driving or using a computer

Macular holes usually develop gradually and are painless. The peripheral or side vision generally remains intact, but untreated holes may enlarge and cause permanent central visual loss.

Small, early holes may occasionally close without treatment. However, most visually significant full-thickness macular holes are treated with vitrectomy surgery, internal limiting membrane peeling and a temporary gas bubble.

Modern surgery closes more than 90% of typical idiopathic macular holes, although anatomical closure does not always mean that vision will return completely to normal.

What Is the Macula?

The retina is a thin layer of light-sensitive nerve tissue lining the back of the eye.

At its centre is the macula, which provides the detailed vision needed for:

• Reading
• Recognising faces
• Driving
• Seeing colours
• Using digital devices
• Performing fine visual tasks

The very centre of the macula is called the fovea. It contains a high concentration of cone photoreceptors and provides the sharpest central vision.

A full-thickness macular hole is an opening extending through the central retinal tissue at the fovea. It does not mean that there is a hole through the entire wall of the eye.

What Is a Macular Hole?

A macular hole forms when pulling forces separate the central retinal tissue.

The process commonly begins with age-related changes in the vitreous—the clear gel filling the back of the eye.

As the vitreous becomes more liquefied, it gradually separates from the retina. In some eyes, it remains firmly attached to the macula and pulls on the fovea as it separates.

This may cause:

1. Distortion of the foveal contour
2. Separation of the inner retinal layers
3. Formation of a partial defect
4. Development of a full-thickness opening

This pulling force is known as vitreomacular traction.

What Does a Macular Hole Feel Like?

Blurred Central Vision

Patients may notice that the centre of an image is less clear than the surrounding area.

Examples include:

• Difficulty reading small print
• Trouble seeing facial features
• Reduced detail when driving
• Difficulty seeing numbers or spreadsheet cells
• Needing brighter light to read

Blur commonly develops gradually over weeks or months.

Wavy or Distorted Lines

Straight objects may appear:

• Bent
• Curved
• Broken
• Misaligned
• Uneven

This distortion is called metamorphopsia.

It may be particularly noticeable when looking at:

• Window grilles
• Door frames
• Lines of text
• Floor tiles
• Road markings
• An Amsler grid

A Missing Central Spot

As the hole enlarges, patients may notice a grey, dark or blank spot in the central vision.

When reading, individual letters or parts of words may disappear. When looking at a face, the patient may see the outline of the head but have difficulty seeing the eyes, nose or mouth.

Image-Size Differences

The affected eye may perceive objects as smaller or larger than the other eye.

This may interfere with:

• Depth perception
• Reading with both eyes
• Hand-eye coordination
• Binocular comfort

Does a Macular Hole Cause Pain?

No.

A macular hole generally causes central visual symptoms without pain, redness or discharge.

Significant pain or redness suggests another eye condition and should not automatically be attributed to a macular hole.

Can a Macular Hole Cause Complete Blindness?

An uncomplicated macular hole affects central rather than peripheral vision.

Even an advanced hole does not usually cause complete blindness. Patients generally retain enough side vision to navigate their surroundings.

However, severe central visual loss can still make reading, driving, recognising faces and performing detailed tasks extremely difficult.

The prognosis may be more serious when the hole is associated with:

• High myopia
• Retinal detachment
• Significant trauma
• Retinal vascular disease
• Other macular damage

Who Is at Greater Risk?

Macular holes are most common in adults over approximately 55–60 years of age and appear to occur more frequently in women.

Other risk factors include:

• Vitreomacular traction
• High myopia
• Eye trauma
• Previous retinal detachment
• Previous eye surgery
• Epiretinal membrane
• Diabetic retinal disease
• Retinal vein occlusion
• Inflammation inside the eye

Most age-related macular holes are described as idiopathic, meaning that they arise through vitreous and retinal changes rather than from a specific injury or systemic illness.

Can the Other Eye Develop a Macular Hole?

Yes.

A person who develops an idiopathic macular hole in one eye has an increased risk of developing one in the fellow eye. Estimates generally range from approximately 5% to 15%, depending partly on the vitreous status of the other eye.

OCT examination of the fellow eye can show whether:

• The vitreous has already separated safely
• Vitreomacular adhesion remains
• Vitreomacular traction is developing
• An early foveal change is present

Once the vitreous has completely separated from the macula without creating a hole, the risk of a future tractional idiopathic hole is generally lower.

What Are the Different Types of Macular Hole?

Not every central retinal defect is the same.

Full-Thickness Macular Hole

A full-thickness macular hole extends through the complete thickness of the central retinal tissue.

It is the form most commonly treated with vitrectomy and gas tamponade.

OCT measurements commonly classify full-thickness holes by their narrowest width:

• Small: 250 micrometres or less
• Medium: more than 250 to 400 micrometres
• Large: more than 400 micrometres

The OCT report may also describe whether vitreomacular traction remains and whether the hole is primary or secondary to another condition.

Hole size influences:

• Likelihood of spontaneous closure
• Surgical closure rate
• Need for postoperative positioning
• Choice of surgical technique
• Visual prognosis

Impending or Early Macular Hole

An early or impending hole occurs when vitreous traction distorts the fovea but a complete full-thickness opening has not yet formed.

Some early lesions resolve if the vitreous releases naturally. Others progress to a full-thickness hole.

Close OCT monitoring may therefore be appropriate before deciding on surgery.

Lamellar Macular Hole

A lamellar macular hole is a partial-thickness defect. Part of the central retinal tissue remains intact.

It may be associated with:

• Epiretinal proliferation
• Epiretinal membrane
• Retinal thinning
• Distortion of the foveal contour

Many lamellar holes remain stable and can be observed. Surgery is considered selectively when there is progressive visual decline, significant distortion or evidence of traction.

The visual expectations and surgical approach differ from those for a conventional full-thickness hole.

Macular Pseudohole

A macular pseudohole is not a true loss of central retinal tissue.

It is commonly caused by an epiretinal membrane that contracts around the fovea, creating the appearance of a steep-sided hole.

OCT distinguishes a pseudohole from:

• Full-thickness macular hole
• Lamellar hole
• Epiretinal membrane
• Vitreomacular traction

Traumatic Macular Hole

A traumatic macular hole may develop after a blunt impact, such as:

• A ball striking the eye
• Contact sports
• A fall
• Road-traffic trauma
• Workplace injury
• Assault

Traumatic holes frequently affect younger patients.

Some small traumatic holes close spontaneously, so a period of OCT observation may be appropriate when there is no retinal detachment or other urgent injury. Persistent or visually significant traumatic holes may require surgery.

A traumatic eye must also be examined for:

• Retinal tears
• Retinal detachment
• Commotio retinae
• Choroidal rupture
• Lens damage
• Bleeding inside the eye

Myopic Macular Hole

Highly myopic eyes are longer than normal and may develop stretching and thinning of the macula.

A myopic macular hole may occur with:

• Posterior staphyloma
• Myopic traction maculopathy
• Retinoschisis
• Macular detachment
• Generalised retinal thinning

These cases can be more difficult to close than ordinary idiopathic holes. Treatment may involve specialised techniques such as:

• Modified internal limiting membrane flaps
• Longer-acting gas
• Silicone oil in selected cases
• Macular buckling in highly selected eyes

The prognosis depends on both hole closure and the degree of underlying myopic macular degeneration.

How Is a Macular Hole Diagnosed?

Visual-Acuity Testing

Vision is measured in each eye.

The eye-chart result may range from mildly reduced vision to severe central visual loss, depending on:

• Hole size
• Duration
• Retinal tissue integrity
• Associated macular disease
• Cataract or other optical problems

Amsler Grid

An Amsler grid may reveal central distortion or a missing spot.

To use it:

1. Wear your normal reading glasses.
2. View the grid in good lighting.
3. Cover one eye without pressing on it.
4. Look directly at the central dot.
5. Notice whether the surrounding lines appear straight.
6. Repeat with the other eye.

New waviness, missing lines or a central dark patch should be assessed rather than monitored indefinitely at home.

Dilated Retinal Examination

Dilating drops allow the ophthalmologist to examine the macula and the remainder of the retina.

The examination also looks for:

• Epiretinal membrane
• Vitreous separation
• Retinal tears
• Retinal detachment
• High-myopia-related disease
• Diabetic or vascular retinal disease

Optical Coherence Tomography

Optical coherence tomography, or OCT, is the key investigation.

OCT uses light waves to produce detailed cross-sectional images of the retina and can show:

• Whether the hole is full thickness
• Minimum and base hole diameter
• Vitreomacular traction
• Cysts around the hole
• Elevation of the hole edges
• Epiretinal membrane
• Lamellar-hole features
• Photoreceptor-layer integrity
• Retinal fluid or detachment

OCT is used for diagnosis, surgical planning and confirming whether the hole has closed after treatment.

Can a Macular Hole Close by Itself?

Occasionally.

Reported spontaneous closure rates for idiopathic full-thickness holes are generally low, approximately 3%–15% overall. Closure is more likely when the hole is:

• Small
• Recently developed
• Associated with release of vitreomacular traction
• Surrounded by relatively healthy retinal tissue

Large or longstanding holes are much less likely to close spontaneously.

A short period of observation may be reasonable for selected small holes, particularly when OCT suggests that traction is releasing.

Observation requires repeat OCT. Waiting indefinitely despite enlargement or progressive visual loss may reduce the likelihood of optimal visual recovery.

Does Every Macular Hole Need Surgery?

No.

Observation may be appropriate when:

• The hole is very small
• Symptoms are mild
• Vision is minimally affected
• OCT suggests possible spontaneous closure
• The hole is traumatic and likely to close
• The lesion is a stable lamellar rather than full-thickness hole
• Medical or surgical risks outweigh the expected benefit

Surgery is generally considered when a full-thickness hole:

• Causes meaningful blur or distortion
• Is enlarging
• Is affecting reading, driving or work
• Is unlikely to close spontaneously
• Has persisted on repeat OCT

Most visually significant full-thickness holes are treated surgically.

Is Macular-Hole Surgery an Emergency?

An uncomplicated idiopathic macular hole is not usually a same-day surgical emergency.

However, assessment should not be delayed for many months because longstanding or enlarging holes may have:

• Lower closure rates
• Greater photoreceptor disruption
• Less complete visual recovery
• More persistent postoperative distortion

Sudden flashes, numerous new floaters or a curtain in the vision are not typical symptoms of an uncomplicated macular hole and may indicate a retinal tear or detachment requiring urgent assessment.

What Happens During Macular-Hole Surgery?

The standard operation is a pars plana vitrectomy with internal limiting membrane peeling and gas tamponade.

Step 1: Anaesthesia

Surgery is commonly performed under local anaesthesia with sedation.

General anaesthesia may be selected according to:

• Patient preference
• Medical condition
• Ability to remain still
• Surgical complexity
• Anaesthetic assessment

Step 2: Small-Incision Vitrectomy

The surgeon creates very small openings through the white part of the eye.

Microsurgical instruments are used to remove the vitreous gel and release any remaining traction on the macula.

The vitreous is not regenerated, but the space is gradually filled by fluid naturally produced inside the eye.

Step 3: Internal Limiting Membrane Peeling

The internal limiting membrane, or ILM, is the extremely thin innermost layer of the retina.

A specialised dye may be used to make it visible. The surgeon then delicately peels the ILM around the hole.

ILM peeling:

• Removes residual tangential traction
• Allows the hole edges to move together
• Improves closure rates
• Reduces the likelihood of the hole reopening

For large, chronic, myopic or previously unsuccessful holes, the surgeon may use a modified flap technique rather than removing the entire ILM around the opening.

Step 4: Gas Bubble

At the end of surgery, the eye is commonly filled with an air or gas bubble.

The bubble floats upwards and acts as a temporary internal bandage. It isolates the hole from normal eye fluid and supports the edges while biological healing occurs.

The bubble gradually becomes smaller and is replaced by the eye’s natural fluid.

Is a Gas Bubble Always Needed?

Gas tamponade is used for most full-thickness macular-hole operations.

The type of bubble and how long it remains depend on:

• Hole size
• Surgical technique
• Surgeon preference
• Need for postoperative positioning
• Patient’s travel requirements
• Whether other retinal disease is present

Selected small holes may be treated with shorter-acting gas or air. Large or complex holes may require longer-acting tamponade.

Will I Need to Stay Face Down?

Possibly.

Face-down positioning places the gas bubble against the macula.

The recommended duration depends on:

• Hole diameter
• Duration of the hole
• Surgical technique
• Gas used
• OCT features
• Surgeon preference

Evidence suggests that face-down positioning may provide a modest additional benefit overall and may be more useful for holes larger than 400 micrometres. The benefit for small holes appears less certain, and some surgeons advise little or no strict face-down positioning after uncomplicated small-hole surgery.

When positioning is prescribed, it may range from several days to longer periods for selected large or complex holes. Follow the surgeon’s individual instructions rather than advice given to another patient.

How Can I Prepare for Face-Down Positioning?

Helpful equipment may include:

• A face-down recovery chair
• A massage-style headrest
• Face-down pillows
• A mirror positioned beneath the face
• A table support for reading or digital devices
• Assistance with meals and household tasks

Patients with neck, back, breathing or mobility problems should discuss these issues before surgery. The positioning plan may need to be modified.

Gas-Bubble Safety

While gas remains inside the eye:

• Do not fly.
• Do not travel to high altitude.
• Do not scuba dive.
• Do not receive nitrous oxide anaesthesia or analgesia.
• Inform every doctor, dentist, anaesthetist and emergency-care provider that gas is present in the eye.

Lower atmospheric pressure causes the gas to expand. Nitrous oxide diffuses rapidly into the bubble and can cause a dangerous increase in eye pressure, retinal artery obstruction and irreversible visual loss.

These restrictions remain until the retinal surgeon confirms that the gas has completely disappeared.

Even a small residual bubble can be dangerous during air travel or nitrous oxide exposure.

What Will I See with a Gas Bubble?

Immediately after surgery, vision may be very blurred.

As the bubble shrinks, patients commonly see:

• A moving horizontal line
• A dark circular border
• A spirit-level appearance
• A smaller bubble breaking into several circles

The visible line gradually moves downwards as the bubble gets smaller.

Vision through the bubble is poor. Clearer vision returns first above the bubble’s upper edge.

What Should I Expect After Surgery?

The eye may initially be:

• Red
• Watery
• Gritty
• Mildly swollen
• Sensitive to light
• Blurred

Prescription drops commonly include:

• Antibiotic drops
• Anti-inflammatory steroid drops
• Pupil-dilating drops in selected cases

A shield may be worn while sleeping to prevent accidental rubbing.

How Long Does Visual Recovery Take?

Visual recovery is gradual.

The early vision is limited by:

• The gas bubble
• Dilating drops
• Postoperative inflammation
• Corneal-surface disturbance
• Cataract
• The time needed for the photoreceptor layers to recover

Patients may notice improvement over the first several weeks after the bubble resolves. Further recovery may continue for six to twelve months.

OCT may confirm hole closure before the final visual result is apparent.

How Successful Is Surgery?

Modern vitrectomy with ILM peeling and gas closes more than 90% of typical idiopathic full-thickness macular holes after one operation. Smaller, more recent holes generally have the highest success rates.

A successful anatomical result means that the edges of the hole have come together.

It does not guarantee normal vision.

Visual improvement depends on:

• Size of the original hole
• Duration before surgery
• Preoperative vision
• Photoreceptor integrity
• Macular tissue loss
• High myopia
• Other retinal disease
• Cataract
• Successful hole closure

Will My Vision Return to Normal?

Not always.

Many patients experience:

• Improved central clarity
• Reduced distortion
• Better reading ability
• A smaller or less noticeable central spot

Some residual symptoms may remain, including:

• Mild waviness
• Reduced contrast
• A small central defect
• Image-size differences
• Poorer vision than in the fellow eye

The longer and larger the hole, the greater the likelihood that permanent microscopic retinal damage has occurred.

Surgery aims to close the hole, improve useful vision and prevent further deterioration—not to promise complete restoration.

What Happens If the Hole Does Not Close?

A persistent macular hole may occur after an otherwise uncomplicated operation.

The surgeon will consider:

• Hole size
• OCT configuration
• Amount of remaining ILM
• Duration
• High myopia
• Previous surgical technique
• Retinal elasticity

Repeat surgery may involve:

• A wider ILM peel
• An inverted ILM flap
• Free ILM tissue placement
• Lens-capsule or other tissue grafts
• Additional gas or silicone oil
• Macular buckling in selected highly myopic eyes

Recent reviews report that standard primary surgery closes over 90% of typical holes, while persistent and recurrent holes require more individualised techniques.

Can a Closed Hole Reopen?

Yes, although reopening is uncommon.

Possible associations include:

• Development of an epiretinal membrane
• Incomplete release of traction
• Cataract surgery in selected predisposed eyes
• Retinal swelling
• High myopia
• Trauma
• Recurrent vitreomacular traction

New central distortion or visual decline after previous successful surgery should be assessed with OCT.

Will Vitrectomy Cause a Cataract?

Vitrectomy frequently accelerates cataract formation in an eye that still has its natural lens, particularly in older adults.

A mild cataract may become visually significant during the months or years following surgery.

Patients who already have an intraocular lens following cataract surgery cannot develop another natural-lens cataract, although posterior capsule opacification can still occur.

Should Cataract and Macular-Hole Surgery Be Combined?

Combined cataract surgery and vitrectomy may be considered when:

• A meaningful cataract is already present
• The patient is likely to develop a rapid cataract after vitrectomy
• Avoiding a second operation is desirable
• The surgeon expects the lens to interfere with retinal access or visual recovery

Advantages may include:

• One anaesthetic
• One major recovery period
• Avoiding later cataract surgery

Possible disadvantages include:

• More postoperative inflammation
• Less predictable refractive results
• More complex surgical planning
• Difficulty separating lens and retinal contributions to vision

The decision is individualised according to age, cataract severity, refraction and retinal findings.

What Are the Risks of Surgery?

Possible complications include:

• Cataract progression
• Retinal tear
• Retinal detachment
• Infection inside the eye
• Bleeding
• Raised or reduced eye pressure
• Macular swelling
• Persistent or reopened hole
• Visual-field change
• Damage to retinal tissue
• Loss of vision

Serious complications are uncommon, but no intraocular operation is entirely risk-free. The expected benefit must outweigh the surgical risk.

Are There Non-Surgical Treatments?

There is no eye drop, vitamin, supplement, diet or exercise proven to close an established full-thickness macular hole.

Pharmacological or pneumatic methods intended to release vitreomacular traction have been studied, but their success is less predictable than vitrectomy and they are suitable only for selected anatomical situations.

Potential complications include:

• Failure to release traction
• Enlargement of the hole
• Retinal tear
• Retinal detachment
• Visual disturbance

Vitrectomy remains the standard treatment for most visually significant full-thickness macular holes under current ophthalmic guidance.

Is a Macular Hole the Same as an Epiretinal Membrane?

No.

Macular Hole

• An opening develops through the central retinal tissue.
• Vitreous traction is a common cause.
• A central missing spot may develop.
• Surgery generally uses ILM peeling and a gas bubble.

Epiretinal Membrane

• A sheet of tissue grows across the retinal surface.
• The membrane wrinkles and contracts the macula.
• Wavy or crowded vision may be prominent.
• Surgery involves membrane peeling.
• A gas bubble is not routinely required unless another condition is treated.

The two conditions may occasionally coexist.

Is a Macular Hole the Same as Macular Degeneration?

No.

Age-related macular degeneration involves:

• Drusen
• Retinal pigment epithelial damage
• Geographic atrophy
• Abnormal leaking blood vessels in wet AMD

A macular hole is a mechanical opening in the central retina.

Both can cause central blur and distortion, but OCT readily distinguishes them and their treatments are different.

Is It the Same as a Retinal Tear?

No.

A retinal tear usually occurs in the peripheral retina and may lead to retinal detachment.

A macular hole occurs in the central retina and primarily affects detailed central vision.

Laser treatment commonly surrounds a peripheral retinal tear. Laser cannot close a central macular hole without damaging the macula.

What Should I Avoid After Surgery?

Follow the retinal surgeon’s individual instructions.

Temporary restrictions commonly include:

• Avoiding eye rubbing
• Avoiding swimming
• Avoiding strenuous exercise or heavy lifting
• Avoiding dusty or contaminated environments
• Avoiding driving while vision is impaired
• Keeping water, soap and cosmetics away from the eye
• Wearing an eye shield while sleeping
• Maintaining the prescribed head position
• Avoiding all flights and altitude changes while gas remains

When Can I Drive Again?

Do not drive while:

• A gas bubble obstructs vision
• Vision remains significantly blurred
• Depth perception is impaired
• Dilating medication is active
• You do not meet the legal driving standard
• Your surgeon has not cleared you

Even when the better eye sees well, a large gas bubble can interfere with binocular vision and depth perception.

Warning Signs After Surgery

Contact the retinal surgeon promptly if you develop:

• Increasing eye pain
• Worsening redness
• Sudden or progressive reduction in vision
• Marked light sensitivity
• Thick discharge
• Headache or nausea with eye pain
• New flashes
• A sudden increase in floaters
• A curtain or shadow
• An eye injury

These symptoms may indicate infection, raised eye pressure, a retinal tear or retinal detachment rather than routine postoperative healing.

Frequently Asked Questions

Is a macular hole an emergency?

It is not usually a same-day emergency, but it should be assessed promptly.

Earlier treatment of a recent symptomatic hole generally offers a better visual prognosis than waiting until the hole becomes large or longstanding.

Can a macular hole heal by itself?

A small minority close spontaneously, particularly small recent holes when traction releases. Most established visually significant full-thickness holes require surgery.

Can glasses correct a macular hole?

Glasses may correct an accompanying spectacle prescription but cannot close the hole or remove retinal distortion.

Can eye injections close the hole?

Routine anti-VEGF or steroid injections do not close an idiopathic macular hole.

Pharmacological vitreolysis has a limited role in selected traction-related cases and is not a substitute for surgery in most patients.

How long does the gas bubble last?

The duration varies according to the type and concentration of gas used. It may last from days to several weeks.

The surgeon should confirm when the bubble has completely disappeared.

Can I fly when only a tiny bubble remains?

No.

Even a small bubble may expand at altitude and cause a dangerous rise in eye pressure.

Can I have dental treatment while gas remains?

Most routine dental treatment is possible, but nitrous oxide or “laughing gas” must not be used.

Tell the dentist and anaesthetist that there is gas inside the eye.

Will I need face-down positioning at night?

This depends on the surgeon’s instructions.

Some patients must avoid sleeping on their back, while others require specific face-down or side positioning. The plan depends on hole size and gas choice.

Is the operation painful?

Anaesthesia prevents significant pain during surgery.

Mild aching, grittiness or discomfort is common afterwards. Severe or increasing pain requires urgent review.

Can both eyes be operated on?

Macular-hole surgery is normally performed on one eye at a time.

If both eyes are affected, timing is individualised according to vision, hole characteristics and recovery from the first operation.

Why is my vision still distorted after the hole has closed?

The photoreceptors and retinal layers require time to reorganise. Some structural damage may also be permanent, particularly after a large or longstanding hole.

Improvement may continue for many months.

The Bottom Line

A macular hole is an opening in the central retina that causes blurred, distorted or missing central vision.

Most idiopathic holes develop when the ageing vitreous remains attached to the macula and pulls on the fovea.

OCT is essential for:

• Confirming the diagnosis
• Measuring the hole
• Identifying vitreomacular traction
• Planning treatment
• Confirming closure

Small selected holes may be observed, but most visually significant full-thickness holes are treated with:

• Vitrectomy
• Internal limiting membrane peeling
• A temporary gas bubble
• Individualised postoperative positioning

Modern surgery closes more than 90% of typical macular holes. Visual improvement is usually gradual and depends on the size, duration and health of the underlying retinal tissue.

New central distortion or a missing central spot should be assessed promptly. Earlier diagnosis provides the best opportunity to close the hole and preserve detailed vision.

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References

1. Kim SJ, et al. Idiopathic Macular Hole Preferred Practice Pattern. Ophthalmology. 2025.
2. National Eye Institute. Macular Hole. Updated December 2024.
3. American Society of Retina Specialists. Macular Hole. Updated 2026.
4. Raimondi R, et al. Facedown Positioning in Macular Hole Surgery: A Systematic Review and Individual Participant Data Meta-analysis. Ophthalmology. 2025.
5. Garg A, et al. Spontaneous Closure of an Idiopathic Full-Thickness Macular Hole. Journal of Vitreoretinal Diseases.
6. Meshkin RS, et al. Refractory Macular Hole Surgery: A Review of Recent Advances. 2025.
7. Royal College of Ophthalmologists. Do Not Use Nitrous Oxide When There Is Gas in an Operated Eye.