First Author: M.Cuesta Lasso SPAIN
Co Author(s): A. Mateos Hernandez J. Sanchez Canzal L. Monje Fernandez E. Pertejo Fernandez P. Ibanez Ayuso M. Franco Benito
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We describe two different cases of macular hole (MH) with a surprising similar image were the fovea levitates over retinal pigment epithelium (RPE). The selected cut on the high definition (HD) optical coherence tomography (OCT) creates a foveal island illusion when in fact it is a foveal bridge between two MH.
High definition Cirrus OCT was performed and analyzed in both patients.
In the first case a chronic lamellar MH in a 72 years old man became a full thickness 4 stage hole together with a worsening of visual acuity, 20/100 in his right eye. Thus, a 23 G pars plana vitrectomy, posterior hyaloid extraction and inverted internal limiting membrane (ILM) flap technique were performed. After a month, a curious image was detected on the OCT, a double MH impressed us as it seems to be a completely independent fovea floating over the RPE. A 76 years old diabetic man was evaluated because of sudden vision loss in his left eye being his best corrected visual acuity (BCVA) light perception. Dense hemovitreo, retro hyaloid haemorrhage and vitreomacular traction was revealed by ultrasound so that he was subjected to phacoemulsification, lens implantation and 23 G pars plana vitrectomy, posterior hyaloid extraction, 360° laser photocoagulation and intravitreal ranibizumab injection. After surgery vision didn´t improve as expected. An epirretinal membrane, microcystic edema and double MH showed up on the OCT giving us a second surprising image of a levitating foveal island.
Both cases have a properly evolution. Nowadays the double hole in the first case is closed and his BCVA 0.7. A bridge is growing up from adyacent macula in the second one and both holes are healing.
Some double MH spontaneous and after vitrectomy have been published as in our cases, but those are a good clarifying example of healing layer by layer because of the HD cuality images. We must check each cut on the OCT, otherwise we could see island where there are real bridges.