Case of Spontaneous Closure and Recurrence of Macular Hole in Vitrectomized Eye

• Published in: International medical case reports journal 2023-09, Vol.16, p.641-645
• Main Authors: Komi, Yuki, Katsumoto, Takeshi, Yoshikawa, Yuji, Shibuya, Masayuki, Shoji, Takuhei, Makita, Jun, Shinoda, Kei
• Format: Article
• Language: English
• Subjects: Case Report; epiretinal proliferation; full-thickness macular hole; lamellar macular hole; optical coherence tomography; spontaneous closure; vitrectomy
• ISSN: 1179-142X; 1179-142X
• DOI: 10.2147/IMCRJ.S429577

Rationale: Development and spontaneous closure of a macular hole (MH) in a vitrectomized eye is relatively rare. We report our findings in a case in which vitrectomy was performed successfully to treat a vitreous hemorrhage (VH), but a MH developed eight months later. The MH spontaneously closed 2 weeks later, but then reopened. A second vitrectomy was performed with insertion of the internal limiting membrane flap into the MH which led to the successful closure of the MH. The purpose of this article is to present an explanation of how MH developed in this eye without vitreous traction. Patient: A 64-year-old woman visited an eye clinic with vision reduction in her right eye of 3 days duration. A VH was detected in the right eye and pars plana vitrectomy (PPV) was performed. A retinal tear was detected which was the origin of the VH. The vision was restored to a decimal visual acuity of 1.2. Eight months later, the patient noticed that her vision was distorted and was referred to our hospital. Diagnosis: Optical coherence tomographic (OCT) images showed a thin epiretinal membrane on the macula, cystoid changes in the macular area, and a full-thickness MH. Interventions: The MH closed spontaneously in two weeks, however a lamellar MH with an epiretinal proliferation (EP) developed 11 months later. Two months later, OCT showed cyst-like changes in the retina and a full-thickness MH. A second PPV was performed with the insertion of the ILM flap and EP into the MH to close the MH. Her visual acuity improved, and distorted vision was not present. Lessons: Clinicians should be aware that a MH can develop in a vitrectomized eye without vitreous traction but can close spontaneously. We conclude that careful follow-up examinations are necessary even in vitrectomized eyes. Plain Language Summary: We report our findings in a case in which a macular hole (MH) developed 8 months after vitrectomy and spontaneously closed but then reopened. Finally, the MH was closed after a second vitrectomy. Optical coherence tomographic images showed changes in the macular microstructure, eg, the presence of a thin epiretinal membrane on the retina, cystoid changes in the retina, and a full-thickness MH. We discuss the mechanism of MH development and surgical treatment. Keywords: epiretinal proliferation, full-thickness macular hole, lamellar macular hole, optical coherence tomography, spontaneous closure, vitrectomy