A Recurrent Case of Full-Thickness Macular Hole After Successful Closure With Primary Vitrectomy and Epiretinal Proliferation Embedding

TL;DR

This case study shows a full-thickness macular hole reopening after initial successful treatment using epiretinal proliferation embedding.

Contribution

A novel observation that EP embedding may not fully prevent recurrence if tangential ILM traction remains.

Findings

A macular hole was successfully closed using EP embedding but reopened after one year.

A second surgery using an ILM inverted flap technique was required to close the reopened hole.

Tangential traction from the ILM may contribute to FTMH recurrence despite EP embedding.

Abstract

Epiretinal proliferation (EP) is thought to be glial cell proliferation arising from the inner retina, seen in cases of lamellar or full-thickness macular holes (FTMH). Embedding EP within the macular hole is considered supportive for FTMH closure and functional recovery. We report a recurrent case of FTMH that was successfully closed after primary vitrectomy with the EP embedding technique. In the primary surgery, internal limiting membrane (ILM) peeling was avoided to reduce the potential risk of retinal nerve fiber layer damage associated with glaucoma. The FTMH was successfully closed, with complete recovery of macular layer structures. However, over one year later, the FTMH reopened, slightly dislocated from the position of the embedded EP scar. The reopened FTMH was closed again after the second surgery using the ILM inverted flap technique. This case indicates that macular hole closure with EP might not sufficiently support the tissue repair of FTMH as a new hole can form if tangential traction of the ILM remains.

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