gms | German Medical Science

Introduction: Spontaneous closure of idiopathic macular hole is uncommon. It is extremely rare after surgery with only two cases reported in the literature so far.

Methods: Interventional case report. A 80-year-old man underwent combined phaco+IOL and standard 20G vitrectomy+ICG-assisted ILM peeling+C2F6 16%gas tamponade for a stage four macular hole and initial cortico-nuclear cataract. Standard pre and post-operative eye examination included BCVA and OCT.

Results: Pre-operative BCVA was 20/200. Five weeks after surgery the macular hole was still clearly biomicroscopically visible and opened as shown by the OCT. The retina was attached and the gas bubble completely reabsorbed. BCVA was unchanged. The patient was asked to come back in 8 weeks (three months since the operation). At this time BCVA improved to 20/80 and the macular hole was not visible anymore. The OCT scans documented its closure with residual sub-RPE fluid at the macula.

Conclusions: To our knowledge this is only the third reported case of late/delayed closure of a macular hole after primary unsucessful vitrectomy. Although macular hole surgery has become a quite standardized procedure, several surgical steps are still debated, for example the necessity of post-operative face-down positioning and ist extension, the choice of the best tamponade. There is general agreement that gas tamponade is needed to allow the macula to remain dry during wound healing processes responsible for the macular hole closure. Moreover the surface tension generated by the gas bubble should help bringing the edges of the hole closer, thus facilitating the closure. Our case shows that also in the absence of a tamponade a delayed wound-healing process may lead to spontaneous closure of a full-thickness macular hole and visual acuity improvement.