Abstract
Purpose
To report an unusual non-iatrogenic case of central macular and posterior full-thickness retinal holes (FTRHs).
Observations
A 60-year-old man presented with a progressive visual loss in the right eye. A complete ophthalmological evaluation including best corrected visual acuity (BCVA) measurement, fundus examination and spectral – domain optical coherence tomography (SD–OCT) was performed.
Fundus examination and SD-OCT confirmed the presence of simultaneous macular and posterior FTRHs. A 25-gauge vitrectomy was performed and the internal limiting membrane (ILM) was grasped and peeled off around the two holes. A fragment of the peeled-off ILM anchored on the FTRHs edges was left and inserted into the gaps.
Closure of both retinal holes was achieved at 1-month, and BCVA improved from 20/630 at baseline to 20/63 at month 3. No intraoperative or postoperative complications were recorded.
Conclusions and Importance
Inverted ILM flap technique represents a good treatment option in this rare non-iatrogenic condition, allowing a good anatomical and functional recovery.
1
Introduction
Idiopathic full-thickness macular hole (FTMH) is a round gap opening at the center of the fovea due to a failure of normal age-related separation of the vitreous cortex from the posterior pole. Paracentral retinal hole is a rare condition usually occurring after macular surgery. Internal limiting membrane (ILM) peeling has been proposed as a possible risk factor for its formation. The presence of idiopathic and simultaneous macular and posterior full-thickness retinal holes (FTRHs) has never been reported. Nevertheless, there is no consensus about the etiology and treatment strategy of this uncommon condition. We hereby present a rare case of idiopathic macular and posterior full-thickness retinal holes (FTRHs) successfully treated with inverted ILM flap technique.
2
Case-report
A 60-year-old Caucasian male was referred to our Retina Service Unit for a progressive visual loss in the right eye (RE). The patient did not report any previous ocular surgery or ocular and head trauma history. A complete ophthalmological examination was performed including anterior segment slit-lamp examination, intraocular pressure (IOP) measured by Goldman applanation tonometer, fundus examination, spectral-domain optical coherence tomography (SD-OCT, Heidelberg Engineering, Germany). Snellen best-corrected visual acuity (BCVA) was recorded.
Written informed consent to publish these case and accompanying images was obtained from the patient.
Anterior segment slit-lamp examination showed nuclear sclerosis of the lens in both eyes and IOP was 16 mmHg.
BCVA was 20/630 in the RE and 20/20 in the left eye (LE).
Fundus examination showed a stage 4 FTMH with a second posterior FTRH within the infero-temporal vascular arcade in the right eye ( Fig. 1 ). LE fundus examination was unremarkable.
Radial SD-OCT scan confirmed in the RE the presence of the two FTRHs with intraretinal hyporeflective cystoid spaces. The distance of the center of the macular hole and the center of the posterior retinal hole was 2564 μm ( Fig. 2 A).
