Idiopathic Macular Hole
Dr. Sarang Lambat, Dr. Vinay Nangia
Suraj Eye Institute, 559 New Colony, Nagpur
A female, 60 years of age, came with sudden blurring of vision in right eye since 3 months. She was a known hypertensive under treatment. Her best corrected visual acuity was finger counting 3 meter in right eye (OD) and 6/9 in the left eye (OS). Anterior segment examination revealed grade 2 nuclear sclerosis in both eyes (OU). Intraocular pressure recorded by Goldmann applanation tonometer was 22 mmHg in OD and 18 mmHg in OS. Fundus examination revealed a full thickness macular hole (FTMH) in OD and OS fundus was normal. Patient underwent fundus photography and SDOCT.
Patient underwent right eye Phacoemulsification with IOL implantation with pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and gas injection. 1 month post surgery the macular hole was closed. We could appreciate 2 para-central retinal holes infero-temporal to the fovea which could be ascribed to the area of peel initiation. The BCVA in the right eye improved from CF 3 meter to 6/12.
This patient had a stage 2 macular hole with cataract. Post surgery, a type 1 closure of the hole was achieved which was well evident on SOCT at 1 month follow up. PPV with posterior hyaloid removal, ILM peeling, long acting gas tamponade and face down positioning is still the gold standard for a successful closure of idiopathic macular hole. For larger holes which have less chances of closure, inverted ILM peeling is now increasingly being done.
This patient also developed paracentral retinal holes infero-temporal to fovea. The holes occurred in the area of initiation of the ILM peeling. There have been reports of such paracentral hole formation in cases of FTMH undergoing vitrectomy with ILM peel. The authors suggested that this postoperative finding might be a consequence of Muller cell damage causing weakening of the glial structures of the retina leading to hole formation.
- Chen YC, Yang CM, Chen SN. Internal Limiting Membrane Flap in the Management of Retinal Detachment due to Paracentral Retinal Breaks. J Ophthalmol. 2019 Jan 21;2019:4303056. doi: 10.1155/2019/4303056. PMID: 30805208; PMCID: PMC6360606.
- Gelman R, Stevenson W, Prospero Ponce C, Agarwal D, Christoforidis JB. Retinal Damage Induced by Internal Limiting Membrane Removal. J Ophthalmol. 2015;2015:939748. doi: 10.1155/2015/939748. Epub 2015 Sep 3. PMID: 26425355; PMCID: PMC4573889..
Dr. Sarang Lambat
Suraj Eye Institute
Email – firstname.lastname@example.org