Full Thickness Macular Hole as a Complication of Idiopathic Parafoveal Telangiectasia A Spectral Domain OCT Analysis Laurence Lim

Advantages:

To document the macular changes in a patient with full thickness macular hole (FTMH) secondary to idiopathic parafoveal telangiectasia (IPFT) using spectral-domain optical coherence tomography (SD-OCT), and to propose possible mechanisms of FTMH formation.

Methods:

Fundus fluorescein angiography (FFA) confirmed the diagnosis of IPFT. SD-OCT was performed using the Spectralis OCT system (Heidelberg Engineering, Vista, California, USA).

Effectiveness / Safety:

A 62-year-old Asian woman presented with blurring of vision without metamorphopsia in one eye. Visual acuity was 20/60 in the affected eye and 20/30 in the fellow eye. Fundal examination revealed bilateral macular changes consistent with IPFT. There was a FTMH with a small cuff of subretinal fluid in the symptomatic eye. Fundus fluorescein angiography (FFA) confirmed the diagnosis of type II IPFT. On SD-OCT, a full thickness disruption of the macular layers was seen down to the retinal pigment epithelium (RPE). Intra-retinal cystoid changes were seen in the nasal margin of the macular hole with an upsloping retinal contour and a prominent posterior hyaloid face. The inner limiting membrane (ILM) was completely discontinuous over the hole. The external limiting membrane (ELM) and inner segment/outer segment (IS/OS) junction were also disrupted with lateral separation of the photoreceptors. In the fellow eye, disruption of the retinal layers at the fovea was also noted. The ELM and IS/OS junction were disrupted at the fovea, and the retinal architecture was disorganised. Small cystoid spaces were seen in the retinal layers at the fovea.

Take home message:

FTMH associated with IPFT demonstrates disruption of the photoreceptor line and an upsloping retinal contour and prominent posterior hyaloid face on SD-OCT. These findings suggest that vitreo-macular traction may be the underlying mechanism of hole formation in these cases.