Full thickness macular hole formation and spontaneous closur
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Macular hole (MH) formation after rhegmatogenous retinal detachment (RRD) repair is not common, with an incidence of approximately 0.5% to 1.9%. An MH can occur after scleral buckling, pneumatic retinopexy, and pars plana vitrectomy. Among these procedures, scleral bucking is most closely associated with MH development, with relatively few cases resulting from vitrectomy alone. In addition, macula-off retinal detachment (RD) and multiple interventions for RD repair have been found to influence MH formation.

A 66-year-old female patient visited our outpatient clinic due to blurry vision in her right eye. She had hypertension but was free from diabetes mellitus. The best-corrected visual acuity (BCVA) was 1.0 in both eyes, and the intraocular pressure was 19/16. On slit lamp examination, both eyes were pseudophakic, and there were no other specific manifestations in the anterior segment. On fundus examination, the right eye showed ghost vessels in the superior-nasal area around the disc RD, with a large retinal tear at the inferior retina. On spectral domain optical coherence tomography (SD-OCT), localized epiretinal membrane (ERM) not involving the fovea was detected, and the foveal contour was intact. On the same day, a barrier laser was used to treat the RD.

Two months after the initial visit, the RD was found to be enlarged, so surgery including 25-gauge vitrectomy and endolaser gas (18% SF6) injection was performed. One month after surgery, the BCVA of the right eye was well-maintained at 1.0, and the retina was flat. On SD-OCT, the ERM showed no progression. Nine months after the detection of MH, the VA of the right eye was 1.0. Despite the thinning of foveal tissue, the MH was completely closed and did not recur. Regarding the BRVO, no associated complications such as macular edema or retinal neovascularization were observed.