Spontaneous closure of bilateral macular holes

Abstract

Purpose: To present a case of a right eye spontaneous closure of a full thickness macular hole (FTMH), followed several years later by a left eye spontaneous closure of a FTMH, in an otherwise healthy woman.

Observations: We show the temporal changes and spontaneous resolution observed with Spectral-Domain Ocular Coherence Tomography (SD-OCT) of a FTMH in the right eye and a FTMH secondary to vitreomacular traction in the left eye of the same patient 5 years later, also with full spontaneous resolution. Following the resolution, SD-OCT demonstrated outer retinal layer disruption recovery and visual acuity improvement in both eyes.

Conclusions and importance: Spontaneous closure of macular holes is an uncommon event, with most descriptions in the literature being of single cases or very small series, including several reports in patients who have undergone vitrectomy for other causes, or in highly myopic eyes. Bilateral spontaneous closure of macular holes in the same patient is an even more uncommon event, described only once in one patient previously in the literature to our knowledge.

Keywords: Bilateral macular hole; Full-thickness macular hole (FTMH); Macular hole (MH); Ocular coherence tomography (OCT); Spontaneous macular hole closure; Vitreous macular traction (VMT).

Fig. 1

Right eye clinical course of spontaneous FTMH closure without surgical intervention. The left column contains the date the exam was taken, visual acuity (VA) and the status of the macular hole. The right column contains the B-scan OCT images. The upper image represents the time-domain OCT B-scan demonstrating a FTMH measured 252 μm (medium primary FTMH) with a formed operculum. All other 4 consecutive images represent the spectral-domain OCT B-scan demonstrating FTMH closure and defragmentation and realignment of the posterior retinal layers with VA improvement.

Fig. 2

Left eye clinical course of spontaneous FTMH closure without surgical intervention. The right column contains the date the exam was taken, visual acuity (VA) and the status of the macular hole. The left column contains the spectral-domain OCT B-scan images. The upper image demonstrates a very narrow operculated FTMH which later increases to a FTMH diameter of 426 μm (large primary FTMH) with an elevation of the operculum by VMT. Later on, an operculum detachment occurred with VA worsening and the FTMH measured 320 μm (medium primary FTMH). Finally, the FTMH closes spontaneously with only observation demonstrating posterior retinal layers re-arrangement and VA improvement.