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.
GassJD.Idiopathic senile macular hole. Its early stages and pathogenesis. Arch Ophthalmol. 1988;106(5):629-639.
2.
AliFSSteinJDBlachleyTSAckleySStewartJM.Incidence of and risk factors for developing idiopathic macular hole among a diverse group of patients throughout the United States. JAMA Ophthalmol. 2017;135(4);299-305.
3.
DukerJSKaiserPKBinderS, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology. 2013;120(12):2611-2619.
4.
LiangXLiuW.Characteristics and risk factors for spontaneous closure of idiopathic full-thickness macular hole. J Ophthalmol. 2019;2019(5-6):4793764.
5.
LeeJNguyenVQDossMKEllerAW.Spontaneous closure of a chronic full thickness macular hole after failed surgery. Am J Ophthalmol Case Rep. 2018;13:59-61.
6.
BrooksHLJrOzkardesC.Intentional use of topical latanoprost with resulting macular edema to help in the closure of a failed, chronic, macular hole. Am J Ophthalmol Case Rep. 2022;27:101603.
7.
SmiddyWEFlynnHWJr.Pathogenesis of macular holes and therapeutic implications. Am J Ophthalmol. 2004;137(3):525-537.
8.
JohnsonMW.Posterior vitreous detachment: evolution and complications of its early stages. Am J Ophthalmol. 2010;149(3):371-82.e1.
9.
TornambePE.Macular hole genesis: the hydration theory. Retina. 2003;23(3):421-424.
10.
GentileRCLandaGPonsMEEliottDRosenRB.Macular hole formation, progression, and surgical repair: case series of serial optical coherence tomography and time lapse morphing video study. BMC Ophthalmol. 2010;10:24.
11.
SchubertHDKuangKKangFHeadMWFischbargJ.Macular holes: migratory gaps and vitreous as obstacles to glial closure. Graefes Arch Clin Exp Ophthalmol. 1997;235(8):523-529.
12.
WendelRTPatelACKellyNESalzanoTCWellsJWNovackGD.Vitreous surgery for macular holes. Ophthalmology. 1993;100(11):1671-1676.
13.
BrooksHLJr.Macular hole surgery with and without internal limiting membrane peeling. Ophthalmology. 2000;107(10);1939-1949.
14.
YoohHSBrooksHLJrCaponeAJrL’HernaultNLGrossniklausHE.Ultrastructural features of tissue removed during idiopathic macular hole surgery. Am J Ophthalmol. 1996;122(1): 67-75.
15.
FelfeliTMandelcornED. Macular hole hydrodissection: surgical technique for the treatment of persistent, chronic, and large macular holes. Retina. 2019;39(4):743-752.
16.
da CostaDRBragaPGOArielloLEZachariasLC.Spontaneous closure of a chronic full-thickness idiopathic macular hole after Irvine-Gass syndrome resolution. BMC Ophthalmol. 2022;22(1):132.
17.
MichalewskaZMichalewskiJAdelmanRANawrockiJ.Inverted internal limiting membrane flap technique for large macular holes. Ophthalmol. 2010;117(10):2018-2025.
18.
GargABalliosBGYanP.Spontaneous closure of an idiopathic full-thickness macular hole: a literature review. J Vitreoretin Dis. 2022;6(5):381-390.
