Development and spontaneous closure of a secondary macular hole associated with submacular hemorrhage due to polypoidal choroidal vasculopathy: a case report

Abstract

Background: Macular hole (MH) is a retinal break in the fovea involving partial or complete dehiscence of the neural retinal layers affecting the visual quality by decreasing visual acuity (VA) and visual deformation. We describe a case of secondary MH associated with submacular hemorrhage (SMH) due to polypoidal choroidal vasculopathy (PCV), which showed spontaneous closure. Case presentation: A 67-year-old man developed decreased VA in his right eye due to an SMH. The VA was 20/50, and monthly intravitreal injection of aflibercept was administered three times. The SMH gradually decreased, and 10 months later the external limiting membrane was found to be perforated, resulting in MH. The old clot disappeared, and the MH remained for 10 months. Twenty-three months later, serous retinal detachment (SRD) involving the macula appeared and the MH had disappeared. SRD gradually disappeared, and macular configuration recovered. VA gradually improved and became 20/20 38 months later. Conclusion: Dynamic change of the ultrastructure in an unusual case of secondary-developed and spontaneously closed MH was clearly observed. Although the mechanism was unknown, the small diameter size and exudative PCV are thought to have contributed to the closure.

Full-Thickness Macular Hole Caused by Acute Subretinal Hemorrhage From Wet Age-Related Macular Degeneration

“…3 Most reports of MHs associated with wet AMD describe MH formation in conjunction with CNVM regression (ie, in the setting of fluid resolution after treatment with antivascular endothelial growth factor [anti-VEGF] therapy). [5][6][7][8][9] There are also many reports of MH formation during resolution of exudation in polypoidal choroidal vasculopathy treated with anti-VEGF 10 and during contraction of a treated myopic CNVM. [11][12][13][14] In such eyes, in addition to the tractional processes, tangential traction from a contracting CNVM may contribute to MH formation.…”

Full-Thickness Macular Hole Formation and Spontaneous Closure During Intravitreal Ranibizumab Therapy for Central Retinal Vein Occlusion

“…intraretinal tissue (due to ERM, proliferating glial cells, or collagen secretion by glial cells), sharp edge, and small MH diameter. 9,10 Intraretinal edema might facilitate spontaneous MH closure by reapproximating the hole edges through physical expansion, and recurrent macular edema, as is associated with CRVO and visible in Figure 1F, might have exercised this effect. 11 The ERM was also visible in Figure 1F, and centripetal contraction of this thin ERM after the next intravitreal RBZ could have released the mechanical stress on the retina, allowing for approximation of MH edges and hole closure.…”

“…Spontaneous FTMH closure has been attributed to spontaneous posterior vitreous detachment leading to the relief of vitreomacular traction, formation of bridging intraretinal tissue (due to ERM, proliferating glial cells, or collagen secretion by glial cells), sharp edge, and small MH diameter. 9,10…”

Postvitrectomy full-thickness macular hole and retinal detachment in a case of polypoidal choroidal vasculopathy

“…They ascribed the macular hole formation to the secondary retinal degeneration due to the underlying fibrin and subretinal blood. 5 The spontaneous closure could be explained by the smaller hole size, no intraretinal cysts and serous macular detachment allowing edges to approximate.…”