Case Report: Spontaneous Closure of Idiopathic Full-thickness Macular Hole and Early Development of Lamellar Hole

Abstract

Significance Spontaneous closure of an idiopathic full-thickness macular hole (FTMH) is a rare event. The underlying mechanisms are unclear due to the difficulty in detecting subtle structural changes even with serial imaging. Previous reports are largely optical coherence tomography (OCT)–based but multimodal imaging could highlight new information. Purpose to report the spontaneous closure of an idiopathic FTMH (iFTMH), its recurrence and late closure documented by serial OCT integrated with multimodal imaging modalities and microperimetry (MP). Case report A healthy 46 year old man was referred to the department of Ophthalmology of the University of Padova for an iFTMH in the right eye with preserved visual acuity. The patient was scheduled for monthly controls up to 12 months by an integrated assessment of OCT, angiography-OCT (A-OCT), short wave-length fundus autofluorescence (Sw-FAF), MP. Two months later, tracked OCT scans showed a closure of the hole with a residual lamellar macular hole (LMH). Sequential examinations revealed a discontinuation of photoreceptors (EZ), a recurrence of iFTMH and, seven months later, iFTMH re-closed without any relevant changes up to 12 months. Foveal avascular zone (FAZ) area increased from the baseline reaching its maximum value when iFTMH recurred. Two hyper-fundus autofluorescence points were detected in the foveal area, one progressively decreased and one reached the most intense signal when iFTMH recurred. Retinal sensitivity (RS) decreased mostly in one hyper-fundus autofluorescence point when the EZ line discontinued and reached the lowest value when iFTMH recurred, increased mostly in the other points when iFTMH reclosed. Conclusions spontaneous iFTMH closure, its recurrence and reclosure is a rare event. By monitoring with multiple imaging modalities, MP and their overlaying elaboration can add new biomarkers with diagnostic and prognostic value.