Optical Coherence tomography Optical Coherence tomography Imaging of Imaging of

Spontaneous closure of Spontaneous closure of Psuedophakic full thickness Psuedophakic full thickness macular hole , 8 months post macular hole , 8 months post

operativeoperativeDr. Jenin PatelDr. Jenin Patel

Lotus Eye HospitalLotus Eye Hospital

Mumbai IndiaMumbai India

NO FINANCIAL INTEREST NO FINANCIAL INTEREST

PURPOSEPURPOSE

To report a case of spontaneous closure To report a case of spontaneous closure of full thickness macular hole (FTMH), of full thickness macular hole (FTMH), associated with cystoid macular edema associated with cystoid macular edema (CME) , eight months post cataract (CME) , eight months post cataract surgery.surgery.

Traumatic macular holes are known to Traumatic macular holes are known to close spontaneously. Closure of Post close spontaneously. Closure of Post operative FTMH associated with CME is operative FTMH associated with CME is not reported to the best of our knowledge.not reported to the best of our knowledge.

CASECASE

Sixty year old patient presented with a Sixty year old patient presented with a drop in visual acuity from LogMAR O.20 to drop in visual acuity from LogMAR O.20 to LogMAR 0.70 ,4 months post cataract LogMAR 0.70 ,4 months post cataract surgery.surgery.

He was diagnosed to have a (FTMH) with He was diagnosed to have a (FTMH) with CME CME and posterior vitreous detachment .and posterior vitreous detachment .

The patient was started on low dose The patient was started on low dose topical steroids and NSAID as the medical topical steroids and NSAID as the medical management. management.

OCT confirmed the findings of FTMH OCT confirmed the findings of FTMH measuring 819 microns at the base and measuring 819 microns at the base and cystoid changes measuring 508 micronscystoid changes measuring 508 microns

The patient followed up after four months. The patient followed up after four months. Repeat OCT showed the bridging of the Repeat OCT showed the bridging of the macular hole , then complete closure ,with macular hole , then complete closure ,with improvement of visual acuity to o.4 log improvement of visual acuity to o.4 log MAR.MAR.

Macular thickness now measured 268 Macular thickness now measured 268 microns.microns.

Closure mimicking a foveal detachment

Inward protrusion of tissue around the hole

MECHANISM OF CLOSUREMECHANISM OF CLOSURE

Spontaneous macular hole closure began Spontaneous macular hole closure began as an inward protrusion of the tissue as an inward protrusion of the tissue around the hole. around the hole.

Which then connected to bridge the hole Which then connected to bridge the hole mimicking a foveal detachment. mimicking a foveal detachment.

This, then thickens with resolving This, then thickens with resolving perifoveal cysts to regain its normal perifoveal cysts to regain its normal configuration .configuration .

COMPLETE CLOSURE WITH COMPLETE CLOSURE WITH RESOLVED CME RESOLVED CME

VISUAL VISUAL RECOVERY RECOVERY TO 0.4 log TO 0.4 log MAR.AT MAR.AT THIS STAGE THIS STAGE

OTHER PROPOSED MECHANISMOTHER PROPOSED MECHANISM

Complete detachment of the posterior Complete detachment of the posterior hyloid over the fovea .hyloid over the fovea .

Cellular proliferation at the base of the Cellular proliferation at the base of the hole .hole .

Formation of the epi retinal membrane .Formation of the epi retinal membrane .

Formation of retinal bridge over hole. Formation of retinal bridge over hole.

DISCUSSIONDISCUSSION Pseudophakic CME are known to cause FTMH .Pseudophakic CME are known to cause FTMH .

Small holes occur due to acute posterior Small holes occur due to acute posterior vitreous detachment over the fovea .vitreous detachment over the fovea .

Spontaneous closure of stage II to stage IV Spontaneous closure of stage II to stage IV holes are infrequent.(3-6%).holes are infrequent.(3-6%).

In the inner layers of the retina the presence of a In the inner layers of the retina the presence of a repairing glial tissue is presumed which repairing glial tissue is presumed which executes centripetal traction which attracts the executes centripetal traction which attracts the margin of the hole both tangentially and margin of the hole both tangentially and horizontally.horizontally.

CONCLUSIONCONCLUSION

Monitoring and follow up of the CME prevented an Monitoring and follow up of the CME prevented an unnecessary surgical intervention for the patient. In unnecessary surgical intervention for the patient. In whom the hole spontaneously CLOSED.whom the hole spontaneously CLOSED.

Role of the topical drugs steroidal and non steroidal Role of the topical drugs steroidal and non steroidal cannot be ruled out for the spontaneous closure.cannot be ruled out for the spontaneous closure.

OCT is a good diagnostic tool which enables monitoring OCT is a good diagnostic tool which enables monitoring the decrease in CME and closure of macular hole. the decrease in CME and closure of macular hole.

Pseudophakic macular hole with CME spontaneously Pseudophakic macular hole with CME spontaneously closing has not been reported previously.closing has not been reported previously.