Development of a full thickness macular hole after vitrectomy for rhegmatogenous retinal detachment: a sequential study via optical coherence tomography

Abstract

Background: To demonstrate a full thickness macular hole (MH) development after vitrectomy (VT) for rhegmatogenous retinal detachment (RRD) and to investigate the possible disease mechanism with optical coherence tomography (OCT).

Case presentation: A 47-year-old female underwent 23G vitrectomy surgery to repair the macula-detached RRD successfully. However, intraretinal cysts initially developed two months after surgery. Cysts gradually increased in number and size, and cystoid macular edema was noted at the 5th month. Thereafter, inner retina dehiscence and a lamellar macular hole developed. The lamellar hole further dehisced and progressed into a full-thickness MH at the 10th month. The patient then received 23G vitrectomy and internal limiting membrane peeling surgery. OCT and fundus picture showed macular hole sealed 10 days afterward.

Conclusions: The mechanism of secondary MH included tangential traction, cystoid degeneration of macula, and glial migration. The sequential OCT studies provide evidence to support the disease mechanism of cystoid degeneration of the macula.

Fig. 1

a Fundus picture showed macular-off rhegmatogenous retinal detachment from temporal side. b Fundus picture revealed macular hole formation with halo and adjacent lamellar hole at the 10th month. c Macular hole sealed 10 days after internal limiting membrane peeling surgery

Fig. 2

Sequential findings of optical coherence tomography (OCT). VA:visual acuity. (horizontal B-scan passing through the fovea in all OCT images). a Macular off rhegmatogenous retinal detachment.(VA was counting fingers in front of 10 cm distance). b Attached retina after vitrectomy for repairing rhegmatogenous retinal detachment. Focal ellipsoid zone disruption at macular area was noted. (VA was 4/60). c Intraretinal cyst formation was found 2 months after RRD repair surgery. (VA was 4/60). d Juxtafoveal intraretinal cysts increased in size and numbers at the 4th month post-operation. (VA was 4/60). e At the 5th month after surgery, there was increased intraretinal cystoid change. Topical ketorolac eye drop three times a day was prescribed since then. (VA was 5/60). f Lamellar hole developed about half year after RRD surgery. (VA was 5/60). g MH formation with halo and adjacent lamellar hole at the 10th month. (VA was 3/60). h Successful hole closure after MH repairing surgery. (VA was 6/30)