Poster 5 Joaquin Castro Navarro

To report a case of spontaneous closure of stage IV full-thickness idiopathic macular hole (FTMH) and late reopening as a lamellar macular hole.

Methods:

A 67-year-old Spanish man was referred to our hospital with a complaint of decreased vision in his right eye and metamorphopsia for approximately 11 months. He did not report any trauma. A complete ocular examination, including, among others, determination of Best Corrected Visual Acuity (BCVA), fundoscopy and Optical Coherence Tomography (OCT), was performed.

Effectiveness / Safety:

At first visit, his BCVA was 0.5 in the right eye and 1.0 in the left eye. Anterior segment examination revealed a bilateral nuclear sclerosis with no further abnormalities. Fundoscopy revealed an image of a full-thickness macular hole. OCT examination showed a stage IV FTMH according to its size (more than 400 micron) and according to the posterior vitreous detachment, the latter only visible on fundoscopy examination. We also appreciated some cystic spaces on both edges of the hole, and a small epiretinal membrane (ERM). We observed clear irregularity of the junction of inner and outer segments of photoreceptors. Three months later, his BCVA remained without change. OCT scans revealed a closed macular hole. We observed an elevation of the photoreceptor layer and of the external limiting membrane over a cystic space, and a defect in the continuity of the photoreceptor layer. Seven months later, his BCVA remained the same. An OCT examination showed the disappearance of the cystic space, and a normal foveal contour. At 13 months later, his BCVA improved to 0.7. An OCT scan showed no changes. Two years later, his BCVA remained unchanged but on OCT scan we surprisingly observed a lamellar macular hole, according to the Haouchine criteria: irregular thinning of foveal base, break in the inner fovea, intra-retinal split (dehiscence of the inner foveal retina from the outer retina), normal perifoveal retinal thickness and absence of a full-thickness foveal defect.

Take home message:

The contraction of the epiretinal membrane could have contributed to cystic spaces and their fusion, subsequently, to the formation of a lamellar macular hole. To the best of our knowledge, this is the first report in the literature of a spontaneously closed full-thickness idiopathic macular hole with reopening as a partial thickness macular defect.