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Case Reports
. 2021 Jun 20;13(6):e15785.
doi: 10.7759/cureus.15785. eCollection 2021 Jun.

Surgical Treatment for a Full-Thickness Macular Hole That Developed on a Large Drusenoid Pigment Epithelial Detachment

Kunihiro Azuma  1 , Tomoyasu Shiraya  1 , Fumiyuki Araki  1 , Satoshi Kato  1 , Shigeko Yashiro  2 , Miyuki Nagahara  2 , Takashi Ueta  1
Affiliations
Case Reports

Surgical Treatment for a Full-Thickness Macular Hole That Developed on a Large Drusenoid Pigment Epithelial Detachment

Kunihiro Azuma et al. Cureus. .

Abstract

Full-thickness macular hole (FTMH) and age-related macular degeneration (AMD) can affect the same eyes in the older population. Previously reported phenotypes of AMD concurrent with FTMH include early/intermediate AMD and serous pigment epithelial detachment (PED). A 68-year-old woman presented to our clinic with decreased vision due to a cataract and a large drusenoid PED in both eyes. After ruling out choroidal neovascularization, she underwent cataract surgery. Three days after the cataract surgery, an FTMH was found in the left eye. Although the FTMH was not closed after the initial pars plana vitrectomy (PPV) with the inner limiting membrane (ILM) peeling and air tamponade, it was closed after reoperation with additional ILM peeling, retinal massage, and SF6 gas tamponade. Best-corrected visual acuity (BCVA) was improved from 20/60 before the first PPV to 20/40 at six months after the reoperation. Some large soft drusen in the macula were fused after surgeries in the operated eye, but not in the fellow eye. An FTMH concurrent with a large drusenoid PED is rare. It can be closed surgically, and postoperative visual function can improve.

Keywords: age-related macular degeneration; drusenoid pigment epithelial detachment; inner limiting membrane; macular hole; vitrectomy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Color fundus photo (1A,1E), fluorescein and indocyanine green angiography at 6-7 min (1B,1C,1F,1G), and OCT (1D,1H) at initial presentation.
Although cataracts limited transparency, drusenoid pigment epithelial detachment without neovascularization was observed in both eyes. In addition, vitreous adhesion at the fovea and optic nerve head was shown on OCT (indicated by arrows for the left eye in 1H). OCT, optical coherence tomography
Figure 2
Figure 2. Color fundus photo (2A,2C) and OCT (2B,2D) after cataract surgery in both eyes.
An FTMH was identified in the left eye. FTMH, full-thickness macular hole OCT, optical coherence tomography
Figure 3
Figure 3. A horizontal section of OCT after initial PPV in the left eye. An FTMH remained open.
OCT, optical coherence tomography; PPV, pars plana vitrectomy; FTMH, full-thickness macular hole
Figure 4
Figure 4. Color fundus photo (4A,4D) and OCT of horizontal (4B,4E) and vertical (4C,4F) sections after surgeries.
An FTMH on a drusenoid PED in the left eye was closed after the second PPV in the left eye (4D,4E,4F). Large soft drusen in the temporal macula in the left eye were fused with each other (circles, 4D vs. 2C). On the other hand, the distribution of drusen did not change in the right eye during the same period of follow-up (4A vs. 2A). OCT, optical coherence tomography; PED, pigment epithelial detachment; PPV, pars plana vitrectomy; FTMH, full-thickness macular hole
See this image and copyright information in PMC

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