Delayed Macular Hole Closure

Abstract

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.

Late Closure of a Stage III Idiopathic Macular Hole after Pars Plana Vitrectomy

“…They reported a stage II idiopathic macular hole that spontaneously closed after 16 days of persistence. In contrast to Distelmaier et al 16 case, the persistence period following PPV was longer (5 months) in our patient. This inconsistency may be due to a larger preoperative hole diameter (671 microns) associated with more advanced macular hole stage.…”

“…15 Spontaneous closure of late reopening macular holes after previous vitrectomy may be related to ERM contracture and bridging glial cell proliferation. 15 Similar to our results, Distelmaier et al 16 demonstrated delayed macular hole closure after macular surgery consisting of PPV, ILM peeling, and gas (20% C2F6) tamponade. They reported a stage II idiopathic macular hole that spontaneously closed after 16 days of persistence.…”

“…This inconsistency may be due to a larger preoperative hole diameter (671 microns) associated with more advanced macular hole stage. Unlike Distelmaier et al 16 study, the ILM could not be successfully removed in the our patient due to tight adhesions between the ILM and inner retina. In addition, postoperative OCT revealed an ERM in our case.…”

Delayed closure of macular hole secondary to Terson syndrome after vitrectomy

“…According to our review of the delayed macular hole closure in 8 cases, it is found that there are 3 types of unclosed macular holes: type M, type U, and type W (Table 1). Type M macular holes were presented in 3 cases [5–7] , it is characterized by a wide basal diameter, which is much larger than the minimum diameter. The edge of the hole is obviously raised with a large number of intraretinal cysts, which may be related to the softness and elasticity of retina at the edge of the hole after ILM peeling.…”

Formation of Full Thickness Macular Hole Following Pars Plana Vitrectomy and Internal Limiting Membrane Peeling and Its Spontaneous Closure

“…2 Distelmaier et al reported that a FTMH can recur following surgical repair but it was closed without any intervention. 3 Spontaneous closure has also been reported in context of posterior uveitis, cystoid macular oedema, 4 and following retinal detachment repair by pars plana vitrectomy. 5 It is possible that the ILM peel disrupted the foveal surface which triggered the formation of FTMH, but at the same time promoting closure by removing the traction from the vitreous.…”