A Case of Spontaneous Closure of Macular Hole in Infectious Posterior Uveitis Involving the Fovea

Min Woo Kim; Dong Yoon Kim; Yoon Jeon Kim; Soo Geun Joe; Joo Yong Lee; June Gone Kim

doi:10.3341/jkos.2016.57.1.155

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Kim, Kim, Kim, Joe, Lee, and Kim: A Case of Spontaneous Closure of Macular Hole in Infectious Posterior Uveitis Involving the Fovea

Original Article

Journal of the Korean Ophthalmological Society 2016; 57(1): 155-160.

Published online: 31 August 2016

DOI: https://doi.org/10.3341/jkos.2016.57.1.155

A Case of Spontaneous Closure of Macular Hole in Infectious Posterior Uveitis Involving the Fovea

Min Woo Kim, M.D¹, Dong Yoon Kim, M.D², Yoon Jeon Kim, M.D¹, Soo Geun Joe, M.D³, Joo Yong Lee, M.D¹, June Gone Kim, M.D, PhD^1,

¹Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

²Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea

³Department of Ophthalmology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea

Address reprint requests to June Gone Kim, MD, PhD Department of Ophthalmology, Asan Medical Center, #88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: 82-2-3010-3680, Fax: 82-2-470-6440 E-mail: junekim@amc.seoul.kr

‗ This study was presented as a poster at the 111th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 12 June 201528 July 2015 Accepted 29 October 2015

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 macular hole secondary to presumptive infectious posterior uveitis involving the fovea that sponta-neously resolved after medical treatment.

Case summary

A 33-year-old male visited our clinic for decreased visual acuity in his left eye. He was treated with im-munosuppressive therapy including steroid after bone marrow transplantation. Best corrected visual acuity (BCVA) was 0.05 in the left eye. Slit lamp examination showed mild anterior vitritis, and fundus examination showed a macular hole with surrounding whitish infiltration at the fovea. Spectral domain optical coherence tomography (SD-OCT) revealed a full thickness macular hole with surrounding hyper-reflective masses with an infiltration-like appearance involving all retinal layers. Serum anti-toxocara IgG was positive (ELISA), and eosinophil count and immunoglobulin E was elevated. Under diagnosis of presumptive ocular toxocar-iasis, the patient was treated with albendazole. After medical treatment for toxocariasis, the whitish foveal infiltration became smaller and more discrete. SD-OCT revealed spontaneous closure of the macular hole, and BCVA was improved to 0.4 after a 4-month follow-up.

Conclusions:

We report a macular hole complicated by presumptive infectious posterior uveitis that experienced spontaneous closure after medical treatment for underlying infection.

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Keywords: Macular hole, Posterior uveitis, Spontaneous closure, Toxocariasis

References

1. Rothova A, Suttorp-van Schulten MS. Frits Treffers W. Kijlstra A. Causes and frequency of blindness in patients with intraocular in-flammatory disease. Br J Ophthalmol. 1996; 80:332–6.

2. Bonnin N, Cornut PL, Chaise F. . Spontaneous closure of mac-ular holes secondary to posterior uveitis: case series and a literature review. J Ophthalmic Inflamm Infect. 2013; 3:34.

3. Jee D, Kim KS, Lee WK. . Clinical features of ocular toxocar-iasis in adult Korean patients. Ocul Immunol Inflamm 2015: Aug. 1–10.

4. Ahn SJ, Ryoo NK, Woo SJ. Ocular toxocariasis: clinical features, diagnosis, treatment, and prevention. Asia Pac Allergy. 2014; 4:134–41.

5. Ahn SJ, Woo SJ, Jin Y. . Clinical features and course of ocular toxocariasis in adults. PloS Negl Trop Dis. 2014; 8:e2938.

6. Smiddy WE, Flynn HW Jr. Pathogenesis of macular holes and ther-apeutic implications. Am J Ophthalmol. 2004; 137:525–37.

7. Halkiadakis I, Pantelia E, Giannakopoulos N. . Macular hole closure after peribulbar steroid injection. Am J Ophthalmol. 2003; 136:1165–7.

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Figure 1.

Initial fundus photograph, SD-OCT image and Fluoresce in angiography of patient’s left eye. (A) Fundus photograph re-vealed a mild diffuse vitritis with overlying whitish foveal infiltration. (B) Fluorescein angiography showed centripetal impregnation of the macular lesion and disc stainning on late phase. (C-F) SD-OCT confirmed a full thickness macular hole with overlying whitish foveal infiltration. SD-OCT = spectral domain-optical coherence tomography.

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Figure 2.

The time of eosinophilia (arrow) was coincident with the time of symptom onset.

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Figure 3.

After medical etiological treatment, fundus photographs of the patient’s left eye. Fundus photograph showed gradually more discrete macular whitish infiltration and decreased in size (A, B, C). Four months after medical treatment, fundus photograph demonstrated foveal infiltration was disappeared (D).

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Figure 4.

After medical etiological treatment, SD-OCT of the patient’s left eye. SD-OCT showed gradual spontaneous closure of the macular hole preserving the macular concave figure (A, B, C). Four months after medical treatment, SD-OCT image demonstrated that the macular hole was closed (D). SD-OCT = spectral domain-optical coherence tomography.

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Table 1.

Analysis of serum

Description	Result
Toxoplasma IgM, IgG	Negative
HLA-B27 DNA typing	Negative
Serum toxocara Ab (IgG) (ELISA)	Positive
CMV antigenemia assay	Negative
Syphilis reagin test	Non reactive

Ab = antibody; CMV = cytomegalovirus.

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