Delayed Macular Hole Closure

Purpose

The presented case raises questions regarding the favorable scheduling of planned postoperative care and the ideal observation interval to decide for reoperations in macular hole surgery. Furthermore a discussion about the use of short- and long-acting gas tamponades in macular hole surgery is encouraged.

Methods

We present an interventional case report and a short review of the pertinent literature.

Results

We report a case of spontaneous delayed macular hole closure after vitreoretinal surgery had been performed initially without the expected success. A 73-year-old male Caucasian patient presented at our clinic with a stage 2 macular hole in his left eye. He underwent 23-gauge pars plana vitrectomy and internal limiting membrane peeling with a 20% C₂F₆-gas tamponade. Sixteen days after the procedure, an OCT scan revealed a persistent stage 2 macular hole, and the patient was scheduled for reoperation. Surprisingly, at the date of planned surgery, which was another 11 days later, the macular hole had resolved spontaneously without any further intervention.

Conclusions

So far no common opinion exists regarding the use of short- or long-acting gas in macular hole surgery. Our case of delayed macular hole closure after complete resorption of the gas tamponade raises questions about the need and duration of strict prone positioning after surgery. Furthermore short-acting gas might be as efficient as long-acting gas. We suggest to wait with a second intervention at least 4 weeks after the initial surgery, since a delayed macular hole closure is possible.Key words: Macular hole, Vitrectomy, Gas tamponade     

Spontaneous Macular Hole Closure in Bilateral Macular Holes

The natural course of full thickness macular hole is progression in size and stage. There have been reports of spontaneous closure of unilateral idiopathic full thickness macular holes, but we report the first case of spontaneous closure of a full thickness macular hole in one eye in a patient with bilateral idiopathic full thickness macular holes. After macular hole surgery in the left eye of the patient, spontaneous closure of the macular hole in the right eye was observed during the follow-up period.     

A Nontraumatic Macular Hole in a 10-Year-Old Girl

Background

Full-thickness macular holes usually develop in the elderly population. To the best of our knowledge, there has been no written report of a nontraumatic macular hole in a pediatric patient.

Case

A 10-year-old girl noticed decreased central vision in her left eye without any history of trauma.

Observations

Fundus examination of the left eye revealed a full-thickness macular hole and a thin fibrous membrane on the superior peripapillary retina. She underwent standard macular hole surgery with stripping of the membrane, resulting in closure of the hole.

Conclusions

A full-thickness macular hole may develop in pediatric patients. Although the etiology of the macular hole in the present patient is unclear, tangential traction induced by contraction of the peripapillary membrane, presumed to be an incomplete regression of the Bergmeister papilla, might have been responsible for the formation of the macular hole. Jpn J Ophthalmol 2005;49:520–522© Japanese Ophthalmological Society 2005     

Giant Macular Hole in Alport Syndrome

Purpose: To describe the evolution of a giant macular hole in a patient with Alport syndrome and review the literature.

Methods: An observational case report is presented with serial clinical examination, visual acuity, fundus photographs, and ocular coherence tomography performed.

Results: A man with Alport syndrome and a giant macular hole in one eye developed multiple, small lamellar macular holes which coalesced into a giant full thickness macular hole in the contralateral eye.

Conclusions: Giant macular holes may occur in Alport syndrome. The mechanism and clinical progression appear to differ from that of idiopathic macular holes and, is likely related to an abnormality in Type IV collagen in basement membrane of retinal Muller cells. Anomalous vitreoretinal adhesion may also play a role. Previous cases of giant macular holes in the literature may not have been properly associated with Alport syndrome.     

Prevalence and Progression of Stage 0 Macular Hole in Fellow Eyes of Patients with Idiopathic Full-thickness Macular Hole

PurposeTo assess the prevalence and progression of a stage 0 macular hole in the fellow eye of patients with an idiopathic full-thickness macular hole.MethodsThe fellow eyes of 189 patients who underwent idiopathic full-thickness macular hole surgery were examined by biomicroscopy and spectral domain-optical coherence tomography (SD-OCT). A subset of 21 fellow eyes with a stage 0 macular hole was observed. Changes in the macular hole were evaluated by biomicroscopy and SD-OCT for an average of 29 months.ResultsAmong the 21 eyes, 15 showed no change in perifoveal vitreous detachment (71.4%). Two eyes (9.5%) developed complete vitreofoveal separation, and one of the two developed a separation after progression to stage 1A. Among 21 eyes, 5 (23.8%) developed above stage 1A, and one of the five progressed to stage 1B after five years, which was successfully treated with vitrectomy and gas tamponade.ConclusionsPerifoveal vitreous detachment in the fellow eye on SD-OCT, defined as a stage 0 macular hole, occurred at an earlier phase than stage 1A macular holes and may progress to an advanced stage. Therefore, patients who undergo macular hole surgery and have a stage 0 macular hole or perifoveal vitreous detachment in the fellow eye should be followed closely.     

老年性黄斑板层裂孔的长期随访

老年性黄斑部板层裂孔(SLMH)27例33眼,发病年龄56～68岁(平均60.74岁),女性多于男性(4.4:1),单眼发病多于双眼(3.5:1).经 5～15年(平均 10.5年)随访,30眼眼底病变稳定;1眼在发展为全层裂孔(FMH)视力自0.4下降至0.05,但在此后5年内未见视网膜脱离;2眼做了激光光凝,视力分别自0.3下降至0.01和0.02.通过长期系统观察,作者认为SLM当老年性退行性变,即使已发展成FMH,只要不发生视网膜脱离不应草率地进行激光光凝.     

弓形体性脉络膜视网膜炎的非典型后果——巨大黄斑裂孔

弓形体病是免疫活性个性感染性视网膜炎的最常见病因，鼠弓形体的患病率在世界各地不尽相同。在美国，对其患病率的判断从20%到70%不等。在这些阳性人群中，只有1%残留在临床意义的脉络膜视网膜瘢痕。眼弓形体病往往是一种良 性自限性病变。它也可以引起中心或全部的视力丧失。受影响的眼睛有近四分之一存在法定盲。     

Macular Hole Surgery-Associated Peripheral Visual Field Loss

To examine in more detail the peripheral visual field loss after macular hole surgery, we reviewed a series of 38 consecutive patients (44 eyes) with idiopathic macular hole who underwent vitrectomy and fluid–gas exchange. Ten (22.7%) eyes of 9 patients developed peripheral visual field loss shortly after successful surgery. This complication was characterized by mild to moderate wedge-shaped visual field loss that predominantly affected the inferotemporal periphery. Of these 9 patients, 2 complained of peripheral visual field loss, and the 7 others remained asymptomatic. The peripheral visual field loss remained unchanged for a mean follow-up of 18.5 months, except in one case of complete recovery. The thickness of the retinal nerve fiber layer was measured postoperatively to determine whether any damage to the optic nerve head had occurred during surgery. The information obtained in this study did not provide conclusive evidence for the understanding of the pathomechanism of the macular hole surgery-associated visual field loss. Peripheral visual field defect after otherwise uneventful surgery for idiopathic macular hole is probably not uncommon. This complication is variable in its severity and is usually permanent. Whether it is caused by any surgical trauma to the optic nerve head remains to be elucidated.