Bilateral macular hole following myopic photorefractive keratectomy

Abstract

A 42-year-old man was admitted to our clinic complaining of visual distortion in his left eye two months after bilateral myopic photorefractive keratectomy (PRK). Macular optical coherence tomography (OCT) showed a stage II macular hole in the left eye. Simultaneous OCT in the right eye showed vitreous traction and distortion of the outer retina. One month later, the patient underwent vitrectomy for the left eye, and the macular hole was closed. Two months after that, the patient complained of visual distortion in the right eye, and OCT revealed increased traction and accentuated outer retinal distortion indicating a stage IB macular hole. Traction attenuated later without any intervention. The short interval between PRK and hole formation, bilateral involvement, and the moderate refractive error in this case highlight the possible role of PRK in aggravating vitreoretinal interface abnormalities. We recommend the addition of PRK to the list of procedures that may be associated with the formation of a macular hole.

Keywords: Optical coherence tomography; Photorefractive keratectomy; Retinal perforations.

Fig. 1

Serial macular optical coherence tomography of the left eye. (A) A full thickness macular hole that developed two months after photorefractive keratectomy, and (B) complete hole closure and restoration of the inner segment/outer segment junction following vitrectomy.

Fig. 2

Serial macular optical coherence tomography of the right eye. (A) Two months after photorefractive keratectomy (PRK), there is vitreous traction on the macula and mild elevation of the outer retina. (B) Four and one-half months after PRK, the macular traction is increased, and outer retinal distortion indicates a stage IB macular hole. (C) One week later, traction is accentuated, and vision of the right eye is reduced to 20 / 30. (D) Three weeks later, traction is attenuated, and vision is improved to 20 / 25.