Objective:

Description of 8 idiopathic macular holes that had an unusual evolution.

Introduction:

Macular hole is the absence of macular retinal layers. Most idiopathic macular holes have a good outcome after surgery, which is vitrectomy, ILM peeling and gas tamponade. However, some unusual cases are still challenging the actual management of this pathology.

Cases:

(1) Surgical closure of macular hole with macular edema development after surgery; treated with ranibizumab and triamcinolone without recurrence.

(2) Non-closed macular hole after 1 week of surgery; the hole became smaller with time without additional procedures and closed during the second post-surgery month.

(3) A cataract patient submitted to phacoemulsification that had serious vomiting episode following cataract surgery and developed a macular hole (not present before). The visual acuity dropped and without additional procedures the macular hole closed during one year and visual acuity improved to 10/10.

(4) and (5) Non-closed macular holes after surgery were submitted to 5 foveal radial incisions, with macular holes closure and maintenance of visual acuity.

(6) Male patient submitted to successful pneumoretinopexy for retinal detachment that had a new retinal detachment and was submitted to vitrectomy. The patient developed a macular hole and a new vitrectomy was made; the result was macular hole closure.

(7) Female patient, with hand movement visual acuity, with macular hole and a “bean-shaped” retinal detachment adjacent to the hole with retinal puckering that was submitted to vitrectomy, ERM and ILM peeling and gas tamponade. Macular hole closed, retina attached and visual acuity improved to 2/10.

(8) Female patient with macular hole submitted to a successful surgery. During month 3 of follow up began with decreasing visual acuity, and revealed signs of age-related macular degeneration over the closed macular hole, that were not present before.

Discussion:

Some unusual evolutions of macular holes show that we need to understand better the pathophysiology of this situation and the best way to treat it.