First Author: R.Pinto Proença PORTUGAL
Co Author(s): N. Moura Coelho J. Cardigos A. Santos M. Dutra Medeiros
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A macular hole represents a defect of the neurosensory retina at the fovea that results in a decrease of central vision. Bilateral full-thickness macular hole (FTMH) is an infrequent condition which can have a poor prognosis if left untreated. The authors report a case of a bilateral full-thickness macular hole and its respective management approach.
Patient case control
A 60 years old female came to the Ophthalmology department with complaints of decreased visual acuity in both eyes. Ophthalmologic examination revealed a best corrected visual acuity (BCVA) of 1/10 in the right eye (RE) and 2/10 in the left eye (LE). Biomicroscopy revealed an incipient cortical cataract and fundoscopy a bilateral macular hole. Optical coherence tomography confirmed a bilateral stage 4 macular hole. Surgical management was performed in both eyes in different surgical times with cataract extraction and pars plana vitrectomy with internal limiting membrane (ILM) peeling. Visual acuity remained the same with no anatomical closure. Due to the low vision, a decision was made to reoperate the patient. A new pars plana vitrectomy was performed, with a mechanical push of the borders of the hole with forceps in order to decrease its size, and the placement of an inverted ILM flap over the macular hole. Vision improved to 3/10 in both eyes, with anatomical closure of the macular hole being more marked in the LE.
Although many authors believe that large FTMH that fail to close after ILM peeling vitrectomy have no indication for further surgery newer innovative techniques may present a chance for vision improvement in refractory cases.