Macular Edema Causing Spontaneous Closure of a Macular Hole After Unsuccessful Primary Surgical Repair

Abstract

Purpose: To describe the spontaneous closure of a chronic, persistent, stage 4 full-thickness macular hole (FTMH) that did not respond to surgical treatment but closed after an episode of cystoid macular edema (CME) secondary to acute iritis. Methods: A single case was evaluated. Results: A 71-year-old woman presented with decreased vision in the left eye for 6 months. A chronic stage 4 FTMH was identified. Surgical treatment consisting of pars plana vitrectomy and internal limiting membrane peeling was unsuccessful, and the patient declined a repeat operation. Two months later, she presented with acute iritis and CME. Imaging showed incidental closure of the FTMH. The iritis resolved after a sub-Tenon triamcinolone injection. At the 3-month follow-up, the FTMH remained closed without CME or iritis. Conclusions: This case highlights the potential importance of CME in the closure of a chronic FTMH after unsuccessful primary surgical repair and suggests clinicians should consider this mechanism in the management of chronic FTMH.