J Korean Ophthalmol Soc.  2016 May;57(5):853-856. 10.3341/jkos.2016.57.5.853.

A Case of Failed Macular Hole Closure Associated with an Entrapped Microbubble in the Hole

• Kim J
• Lee GH
• Lee SW

• KMID: 2212732
• DOI: http://doi.org/10.3341/jkos.2016.57.5.853

Abstract

PURPOSE
To report a case of failed sealing of full-thickness macular hole associated with an entrapped microbubble in the hole after vitrectomy, peeling of the internal limiting membrane and C3F8 (14%) gas injection.
CASE SUMMARY
A 69-year-old female visited our clinic for decreased visual acuity in her right eye. The best corrected visual acuity (BCVA) was 20/200 in the right eye. The fundoscopy and spectral domain optical coherence tomography (SD-OCT) showed a full-thickness macular hole. She had a history of spine surgery and, thus was unable to maintain a prone position after surgery. The patient underwent pars plana vitrectomy, peeling of the internal limiting membrane and C3F8 (14%) gas injection in a sitting position postoperatively. Three weeks postoperatively, fundoscopy showed an entrapped microbubble within the macular hole, which was not sealed as observed on SD-OCT. We thought the entrapped microbubble within the macular hole prevented closure of the hole and removed it during the repeated surgery. At 2 weeks after the microbubble removal, fundoscopy and SD-OCT in the right eye showed the closure of the macular hole and the BCVA was improved to 20/40.
CONCLUSIONS
We experienced a failed sealing of full-thickness macular hole due to an entrapped microbubble within the hole after macular hole surgery and observed the closure of the macular hole after removal of the microbubble. Based on our results, early microbubble removal operation should be considered in the treatment of an entrapped microbubble within the hole.

Keyword

Macular hole; Microbubble; Vitrectomy

MeSH Terms

Aged
Female
Humans
Membranes
Microbubbles*
Prone Position
Retinal Perforations*
Spine
Tomography, Optical Coherence
Visual Acuity
Vitrectomy

Figure

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  Figure 1. Preoperative fundus photograph and horizontal spectral domain optical coherence tomography (SD-OCT) image of the right eye. (A) Fundus photograph reveals a full-thickness macular hole with halo. (B) SD-OCT shows a stage 2 full-thickness macular hole with operculum.

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  Figure 2. At the 5-weeks posoperative visit, fundus photograph and horizontal spectral domain optical coherence tomography (SD-OCT) image of the right eye. (A) A fundus photograph shows a tiny microbubble filling the macular hole (white arrows) that was failed to be closed and a tiny microbubbles on the disc. (B) Horizontal SD-OCT shows the full-thickness macular hole with perifoveal cyst.

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  Figure 3. Intraoperative view. An entrapped microbubble in the hole (white arrow) was removed by soft-tip cannulas.

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  Figure 4. Two weeks after repeat vitrectomy, a fundus photograph (A) and horizontal spectral domain optical coherence tomography (B) image of the right eye. They showed a closed full-thickness macular hole.

Reference

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