First Author: I.Tzamichas GREECE
Co Author(s): E. Zopounidou C. Keskini T. Paschaloglou P. Kalouda C. Kampos G. Sakkias
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To present a case of spontaneous closure of an idiopathic stage III full-thickness macular hole, without any surgical or pharmacological intervention.
Ophthalmology Department, Hippokrateio General Hospital, Thessaloniki, GREECE.
The case is presented on the basis of an observational case report. We evaluated data acquired from clinical examination and spectral domain optical coherence tomography (SD-OCT).
An 81 year old male patient presented to our clinic for a scheduled examination. BCVA was 10/10 in OD and CF in OS. The patient was pseudophakic in the OD while nuclear cataract was present in OS. During fundoscopy a retinal break treated by laser photocoagulation was found in OD, while the OS was difficult to examine due to dense cataract. SD-OCT showed a full-thickness stage III macular hole in OS. Pars plana vitrectomy was scheduled to be performed in 6 months. Until then the patient was examined every 2 months. Partial dehydration of the cysts in the hole margin was noticed in SD-OCT after 2 months while early signs of macular hole closure were noticed 2 months later revealing bridge formation. BCVA was 4/10. At 6-month evaluation progression of the closure of the macular hole with partial restoration of the outer retinal layers and presence of mild subretinal fluid was confirmed by SD-OCT while BCVA was 5/10.
Stage III idiopathic macular holes require surgical intervention with pars plana vitrectomy. Only 6-7% resolve spontaneously. Prognosis regarding visual acuity and structural restoration is better when macular holes are treated during the first year since diagnosis. Waiting for 6 months until surgery while examining the patient every 2 months is an option in order to observe any structural OCT changes indicating macular hole closure. Also rigorous follow-up is mandatory because these macular holes can eventually reopen.