Acute full-thickness macular hole after uneventful femtosecond-assisted cataract surgery and its spontaneous closure

The time course of spontaneous closure of idiopathic full-thickness macular holes

PURPOSE

Spontaneous closure of idiopathic full-thickness macular holes (iFTMH) has been reported regularly. However, little is known about its probability and timeline.

METHODS

In this retrospective study all consecutive patients who presented between August 2008 and August 2019 were screened for the presence of a macular hole and only iFTMHs were included. The primary outcome measure was the spontaneous closure of the iFTMH.

RESULTS

Of 1256 eyes with macular holes, 338 fulfilled the inclusion criteria. Spontaneous closure of the iFTMH was detected in 31 eyes (9.2%) with a median time of 44 days after diagnosis. Eyes exhibiting spontaneous closure demonstrated a higher baseline best-corrected visual-acuity (BCVA) and smaller iFTMH diameter (p < 0.0001 and p < 0.0001, respectively). The mean BCVA improved from 0.4 logMAR (SD ± 0.21) to 0.29 logMAR (SD ± 0.20) after spontaneous closure (p = 0.031). The iFTMH diameter was positively correlated with the time to spontaneous closure (Pearson-r = 0.37, p = 0.0377). Spontaneously closed iFTMHs reopened in 16% (n = 5) of cases, with a median of 136 days after closure. A logistic regression model showed the hole diameter was associated with spontaneous closure (odds-Ratio 0.97, 95%CI [0.96, 0.98]). The Kaplan-Meier-Curve revealed that approximately 25% of small-iFTMH (n = 124) and 55% of iFTMH with a diameter < 150µm (n = 48) closed spontaneously within two months.

CONCLUSION

The established gold-standard for the treatment of iFTMHs is macular surgery. However, the potential for spontaneous closure of small iFTMHs must be acknowledged. Therefore, if surgical treatment is delayed in individual cases, close observation is recommended.

Spontaneous closure of a chronic full thickness macular hole after failed surgery

Purpose

To describe an unusual case of spontaneous closure of a chronic, large, idiopathic, stage 4 macular hole after failed surgery.

Observations

A 75-year-old female presented with a history of a chronic, full thickness macular hole after failed surgery in the right eye. Two years after onset, she developed a fibrotic scar, which closed the macular hole and unexpectedly improved her vision. At her 4 year follow up exam, optical coherence tomography demonstrated a stable, closed macular hole with continued improvement in her visual acuity despite lack of surgical and medical intervention.

Conclusions and importance

The spontaneous closure of an idiopathic full thickness macular hole is an unusual event. When it occurs, it is typically in an acute setting and is attributed to bridging retinal tissue, vitreofoveal separation, and a small diameter size. In this report, we show that a chronic, large break, that failed prior surgical intervention, can spontaneously close. The formation of an underlying fibrotic scar from type 1 neovascularization bridged the macular hole and improved her visual acuity.