J Korean Ophthalmol Soc.  2014 May;55(5):775-779. 10.3341/jkos.2014.55.5.775.

Delayed Closure of Idiopathic Macular Hole after Vitrectomy, Internal Limiting Membrane Peeling, and Gas Tamponade

• Lee JH
• Kim HY
• Park SW
• Lee JE
• Byon IS

• KMID: 2218103
• DOI: http://doi.org/10.3341/jkos.2014.55.5.775

Abstract

PURPOSE
To report a case of delayed idiopathic macular hole closure after vitrectomy, internal limiting membrane peeling, and gas tamponade.
CASE SUMMARY
A 69-year-old female complained of visual disturbance in her left eye. At presentation, her visual acuity was 20/100 in the left eye. Fundus examination and optical coherence tomography revealed a full-thickness macular hole 489 microm in diameter as well as posterior vitreous detachment. Hence, vitrectomy, concurrent cataract surgery, internal limiting membrane peeling and gas tamponade were performed. One month postoperatively, the hole remained unclosed, although decreased in size to 378 microm. At 2 months, cystoid macular edema developed and postoperatively the hole diameter decreased gradually to 311 microm, 252 microm and 156 microm at 2, 3, and 5 months, respectively. Finally, the hole was closed upon the resolution of macular edema at 9 months. However, the visual acuity of 20/100 remained unchanged.
CONCLUSIONS
Delayed closure of holes which may be related to cystoid macular edema, can develop after macular hole surgery.

Keyword

Delayed closure; Idiopathic macular hole

MeSH Terms

Aged
Cataract
Female
Humans
Macular Edema
Membranes*
Retinal Perforations*
Tomography, Optical Coherence
Visual Acuity
Vitrectomy*
Vitreous Detachment

Figure

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  Figure 1. Fundus photograph shows full thickness macular hole with halo before operation.

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  Figure 2. Optical coherence tomography images before and after macular hole surgery. (A) A macular hole was detected and its diameter was 489 μm at baseline. (B) One month after surgery, the hole reduced in size to 378 μm. (C) Two months after vitrectomy, the hole decreased in size to 311 μm. Cystoid macular edema was observed. (D, E) At 3 and 5 months, the hole reduced in size to 252 and 156 μm, respectively, and the cystoid edema decreased gradually. (F) At 9 months, the hole was sealed up. (G) At 12 months after surgery, the contour of the fovea improved. Disruption of inner segment/outer segment junction of photoreceptor layer was detected at fovea (between arrows).

Reference

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