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Case Reports
. 2015 Nov 3:1:18.
doi: 10.1186/s40942-015-0020-9. eCollection 2015.

Managing macular hole associated with acute inflammatory Vogt-Koyanagi-Harada syndrome

Rodrigo M Navarro  1 , Gisele C Guizilini  2 , Leonardo M Machado  2 , Mauricio Maia  1   2
Affiliations
Case Reports

Managing macular hole associated with acute inflammatory Vogt-Koyanagi-Harada syndrome

Rodrigo M Navarro et al. Int J Retina Vitreous. .

Abstract

We report a 24-year-old man with Vogt-Koyanagi-Harada (VKH) syndrome who developed a macular hole (MH) during the acute inflammatory stage. Spontaneous resolution was unlikely because of the MH dimensions and absence of vitreous adherence. The patient underwent pars plana vitrectomy (PPV) and internal limiting membrane peeling during the acute stage followed by retinopexy with octafluoropropane injection and prone positioning for 5 days. The MH closed and the best-corrected visual acuity (BCVA) improved from 20/400 to 20/40. Prompt surgical intervention may be an alternative for treating MHs and obtaining visual recovery in special cases even in the acute inflammatory stage.

Keywords: Macular hole; Pars plana vitrectomy; Vogt-Koyanagi-Harada syndrome.

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Figures

Fig. 1
Fig. 1
Fluorescein angiography (FA) and optical coherence tomography (OCT) images from a patient with a macular hole following acute uveitis in Vogt-Koyanagi-Harada syndrome. Preoperative (figures a–d) and postoperative images (e–h). a An early-phase FA image shows hyperfluorescence suggestive of retinal pigment epithelial (RPE) defects. b A late-phase FA image shows diffuse hyperfluorescence at the optic disc suggestive of persistent uveitis. c The position of the OCT scan at the macula. d An OCT image shows the macular hole (MH). A serous detachment of the macula is nasal to the fovea. e an early-phase postoperative FA image shows minimal hyperfluorescence suggestive of RPE defects. f A late-phase postoperative FA image shows diffuse hyperfluorescence at the optic disc suggestive of persistent uveitis less relevant than preoperatively. g The position of the OCT scan at the macula. h A postoperative OCT scan shows MH closure. No serous detachment of the macula is observed
Fig. 2
Fig. 2
Macular hole surgery images. a Posterior hyaloid detachment guided by deposition of 40 mg/ml of triamcinolone acetonide and internal limiting membrane (ILM) peeling guided by injection of 0.50 mg/ml of brilliant blue. b ILM peeling after staining with Brilliant Blue. The ILM adheres tightly to the neurosensory retina. c The final stage of ILM peeling. The image shows the size of the MH and the peeled ILM around the MH. d Fluid-air exchange. Subretinal fluid resembling honey is drained through the MH that is likely related to subretinal fibrin collection due to the uveitis
See this image and copyright information in PMC

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