Delayed Closure of Idiopathic Macular Hole after Vitrectomy, Internal Limiting Membrane Peeling, and Gas Tamponade

Jong Heon Lee; Ho Yun Kim; Sung Who Park; Ji Eun Lee; Ik Soo Byon

doi:10.3341/jkos.2014.55.5.775

Journal List > J Korean Ophthalmol Soc > v.55(5) > 1009978

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Lee, Kim, Park, Lee, and Byon: Delayed Closure of Idiopathic Macular Hole after Vitrectomy, Internal Limiting Membrane Peeling, and Gas Tamponade

Case Report

J Korean Ophthalmol Soc 201;55(5):775-779.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.5.775

Delayed Closure of Idiopathic Macular Hole after Vitrectomy, Internal Limiting Membrane Peeling, and Gas Tamponade

Jong Heon Lee, MD^1,^3,⁴, Ho Yun Kim, MD^2,⁴, Sung Who Park, MD^2,⁴, Ji Eun Lee, MD, PhD^2,⁴, Ik Soo Byon, MD^1,^3,^4,

¹Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea

²Department of Ophthalmology, Pusan National University Hospital, Busan, Korea

³Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

⁴Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea

Address reprint requests to Ik Soo Byon, MD, Department of Ophthalmology, Pusan National University Yangsan Hospital, #20 Geumo-ro, Mulgeum-eup, Yangsan, 626-770, Korea, Tel: 82-55-360-2131, Fax: 82-55-360-2161, E-mail: isbyon@pusan.ac.kr

Received 15 November 2013 Revised 16 December 2013 Accepted 30 April 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of delayed idiopathic macular hole closure after vitrectomy, internal limiting membrane peeling, and gas tamponade.

Case summary

A 69-year-old female complained of visual disturbance in her left eye. At presentation, her visual acuity was 20/100 in the left eye. Fundus examination and optical coherence tomography revealed a full-thickness macular hole 489 μm in diameter as well as posterior vitreous detachment. Hence, vitrectomy, concurrent cataract surgery, internal limiting membrane peeling and gas tamponade were performed. One month postoperatively, the hole remained unclosed, although decreased in size to 378 μm. At 2 months, cystoid macular edema developed and postoperatively the hole diameter decreased gradually to 311 μm, 252 μm and 156 μm at 2, 3, and 5 months, respectively. Finally, the hole was closed upon the resolution of macular edema at 9 months. However, the visual acuity of 20/100 remained unchanged.

Conclusions

Delayed closure of holes which may be related to cystoid macular edema, can develop after macular hole surgery.

Keywords: Delayed closure, Idiopathic macular hole

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Figure 1.

Fundus photograph shows full thickness macular hole with halo before operation.

Figure 2.

Optical coherence tomography images before and after macular hole surgery. (A) A macular hole was detected and its diameter was 489 μm at baseline. (B) One month after surgery, the hole reduced in size to 378 μm. (C) Two months after vitrectomy, the hole decreased in size to 311 μm. Cystoid macular edema was observed. (D, E) At 3 and 5 months, the hole reduced in size to 252 and 156 μm, respectively, and the cystoid edema decreased gradually. (F) At 9 months, the hole was sealed up. (G) At 12 months after surgery, the contour of the fovea improved. Disruption of inner segment/outer segment junction of photoreceptor layer was detected at fovea (between arrows).

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