Why choose Mr Henderson for macular hole surgery?

Mr Henderson has an extensive personal series of macular hole repairs with closure rates consistently above 90%. He performs minimally invasive 25-gauge vitrectomy with ILM peel and avoids prolonged face-down positioning wherever possible. All surgery is performed personally at Moorfields Eye Hospital by a dedicated consultant retinal surgeon in London.

Conditions · Macular Hole

Macular Hole

Mr Robert Henderson BSc MBBS MD FRCOphth · Consultant Vitreoretinal Surgeon, Moorfields Eye Hospital & GOSH

A macular hole causes a frustrating loss of central vision — but surgery to repair it is highly effective, with closure rates exceeding 90%. Most patients notice meaningful improvement in the months following surgery. If reading, driving, or recognising faces has become difficult, an assessment with Mr Henderson will clarify your options.

A macular hole is a small but significant defect at the very centre of the retina that causes a characteristic loss of central vision. Surgery to close the hole is highly successful, with closure rates exceeding 90% in most cases.

At a Glance
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Closure RateOver 90% with surgery
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ProcedureVitrectomy — day case
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AnaestheticLocal anaesthetic
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LocationMoorfields Eye Hospital
Diagnosis

What is a Macular Hole?

The macula is the central part of the retina responsible for detailed, straight-ahead vision — reading, recognising faces, and watching television. At its very centre lies the fovea, where visual acuity is sharpest.

A macular hole is a full-thickness defect through all layers of the retina at the fovea. It forms when the vitreous gel pulls away from the retinal surface abnormally, exerting traction on the delicate foveal tissue until it tears through.

Macular holes most commonly occur in people over 60 and are more common in women. In most cases there is no underlying cause — they arise spontaneously as part of normal vitreous ageing.

OCT scan showing macular hole alongside vitreomacular traction for comparison
OCT: macular hole (left) alongside vitreomacular traction (right)
Large full-thickness macular hole on OCT scan greater than 600 microns
Large macular hole (>600 microns) on OCT
Symptoms

What Does it Feel Like?

Symptoms develop gradually over weeks to months. Because only the very centre of vision is affected, peripheral vision remains intact — but the impact on daily life can be profound.

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Grey, blurred or distorted central vision
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Straight lines appearing wavy (metamorphopsia)
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A central blank spot or scotoma
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Difficulty reading, even with glasses
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Difficulty recognising faces
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Colours less vivid centrally
Treatment

Surgery for Macular Hole

Vitrectomy surgery achieves closure in over 90% of cases. Mr Henderson performs minimally invasive 25-gauge vitrectomy, removing the vitreous gel and carefully peeling the internal limiting membrane (ILM) from the retinal surface. This relieves traction on the hole and allows it to close.

“The choice of posturing, gas, and whether amniotic membrane is needed is determined by the precise size of the hole — not a one-size-fits-all protocol.”

The eye is filled with a gas bubble to provide gentle support while the hole heals over the following weeks.

⚠ Flying with Gas in the Eye: You must not fly while gas remains in your eye. Changes in cabin pressure cause the gas to expand dangerously. You will be given a card confirming you have intraocular gas.
Before and after OCT showing macular hole closure using subretinal amniotic membrane transplantation
Before and after: closure with amniotic membrane transplantation

Posturing & Advanced Techniques

What to expect

Your Journey from Diagnosis to Recovery

1
Consultation & Imaging

OCT imaging precisely measures the hole — size determines the surgical plan. A clear diagnosis and honest assessment at the first visit.

2
Personalised Surgical Plan

Mr Henderson tailors posturing, gas type, and technique to your specific hole size — including amniotic membrane for large or recalcitrant holes.

3
Day-Case Surgery

Minimally invasive 25-gauge vitrectomy at Moorfields, performed personally by Mr Henderson. Most patients go home the same day.

4
Recovery & Follow-up

Vision improves gradually over weeks to months. Mr Henderson monitors your recovery personally with structured follow-up appointments.

Small & Medium Holes

Strict face-down posturing is not required. Remaining still and looking slightly downward allows the gas bubble to maintain contact with the hole.

Large Holes (>600 μm)

Evidence supports face-down posturing for a defined period. Mr Henderson provides clear written instructions tailored to your specific hole size.

Very Large / Recalcitrant (>1000 μm)

Subretinal amniotic membrane transplantation is offered, achieving closure in almost all cases with a meaningful improvement of approximately two lines of vision.

Questions & Answers

Frequently Asked Questions

Do I need to posture face-down after macular hole surgery?
This depends on the size of your hole. For small and medium holes, strict face-down posturing is not required — you will be asked to remain relatively still and look slightly downward. For larger holes (over 600 microns), face-down posturing improves closure rates and Mr Henderson will give you specific written instructions.
Can a macular hole close without surgery?
Spontaneous closure is rare, occurring in only a small minority of very early stage holes. For the vast majority of patients, surgery is needed to restore vision.
What if my hole is very large or has not closed previously?
For very large holes (over 1000 microns) or holes that have failed to close with standard surgery, Mr Henderson offers subretinal amniotic membrane transplantation. This advanced technique achieves closure in almost all cases and typically results in an improvement of around two lines on the reading chart.
Will cataract develop after vitrectomy?
Vitrectomy accelerates cataract development in patients who still have their natural lens, typically over one to two years. This can be treated with straightforward cataract surgery at a later date.

“I had been told I might never read properly again. After Mr Henderson operated on my macular hole at Moorfields, my reading vision has recovered to the point where I no longer need a magnifier. The care and explanation throughout were exceptional.”

Private patient — macular hole surgery, Moorfields Eye Hospital

Arrange a Consultation

Mr Henderson personally performs all macular hole surgery. There is no delegation to junior colleagues.

To arrange an assessment for macular hole, please contact Alison Anscombe, Mr Henderson’s secretary:

+44 7974 015691  ·  alison.anscombe1@nhs.net

Or use the contact form on this website.

Mr Robert Henderson BSc MBBS MD FRCOphth is a Consultant Vitreoretinal Surgeon at Moorfields Eye Hospital and Great Ormond Street Hospital, and Clinical Lead for Ophthalmology at GOSH. He holds an Honorary Associate Professorship at UCL-GOSH Institute of Child Health.