Spontaneous disappearance and recurrence of impending macular hole: a case report

Abstract

BackgroundThere have been several reports of spontaneous closure and reopening of a macular hole, however, in most of those cases, it was observed in eyes post vitrectomy. Here, we report a case of multiple episodes of spontaneous disappearance and recurrence of impending macular hole (stage 1B macular hole) with no history of previous surgery.Case presentationA 76-year-old Japanese man presented with a primary complaint of reduced visual acuity in his right eye. On initial examination, the visual acuity in his right and left eye was 0.4 and 0.01, respectively. He had previously been diagnosed as having macular degeneration of unknown origin in his left eye. Optical coherence tomography imaging confirmed vitreomacular traction and impending macular hole in his right eye. After a 1-week follow-up period, posterior vitreous detachment was detected, and the impending macular hole appeared to be resolved. Two months later, the impending macular hole had completely disappeared and his visual acuity had improved to 0.9. Six months later, he again noticed decreased vision in his right eye. An examination revealed that his visual acuity had dropped to 0.4, and there was a recurrence of impending macular hole. An optical coherence tomography examination showed no definitive findings of vitreous traction, and, 1 month later, spontaneous disappearance was observed again and his visual acuity improved to 0.7.ConclusionsIn this case, both the initial onset and the recurrence involved impending macular hole, however, the optical coherence tomography findings differed at each examination. These findings suggest that some causes other than vitreous traction were responsible for both the spontaneous disappearance and recurrence of the impending macular hole in this present case.

Spontaneous Closure and Recurrent Opening Times Two of a Macular Hole in a Surgically Naive Eye

“…3,10 Some authors have postulated that there may be ongoing vitreous traction or traction secondary to progressive glial proliferation; others have hypothesized that serine proteases may play a role. 3,8,9 In the current case, a posterior vitreous detachment was present at the time of the initial presentation, which was visualized clinically with a Weiss ring and on OCT with a detached posterior hyaloid overlying the macular hole, and therefore it is less likely that ongoing vitreous traction caused the recurrent opening. However, previous reports have demonstrated residual vitreous remnants by scanning electron microscopy in cases of posterior vitreous detachments that could serve as a source of ongoing traction.…”

“…The first case reported by Golan and Barak 8 in 2015 demonstrated three episodes of opening and spontaneous closure of a full-thickness macular hole in a pseudophakic patient with history of myopia. The second report published in 2019 by Miyamoto et al 9 described a case of a recurrent outer retinal hole (stage 1B) with two episodes of spontaneous closure in an emmetropic patient.…”

“…[4][5][6][7] However, there are only two reports of recurrent macular hole opening and spontaneous closure in surgically naive eyes in the literature. 8,9 Below, we describe a case of an idiopathic macular hole that spontaneously closed twice and subsequently reopened requiring surgical intervention.…”

Surgical repair of an inflammatory macular hole associated with ocular syphilis

“…While there are case reports of spontaneous closure with the resolution of inflammation and release of vitreous traction, patients may require surgical intervention. 6 , 7 , 8 Outcomes data from a retrospective review of patients with macular holes secondary to Behçet's disease in 2011 demonstrated poor closure rates (1/6 eyes) and no improvement in vision with surgical intervention; however, more recent data suggests a role for surgery. 9 Callaway et al published a multicenter case series of 16 eyes in 15 patients that underwent pars plana vitrectomy with indocyanine green dye assisted internal limiting membrane peel for macular hole secondary to various inflammatory etiologies.…”