Spontaneous Resolution of a Full-Thickness Macular Hole: A Complex History

TL;DR

A man with a complex eye history experienced spontaneous healing of a macular hole, improving his vision without surgery.

Contribution

This case highlights the retina's natural healing potential in secondary macular holes.

Findings

A full-thickness macular hole spontaneously closed within three months.

Visual acuity improved from 1.04 LogMAR to 0.68 LogMAR.

The case emphasizes the role of natural reparative processes in managing secondary macular holes.

Abstract

Macular holes are vision-threatening retinal conditions that can significantly affect a patient's quality of life. Secondary macular holes, often associated with intricate ocular histories, create significant obstacles in effective patient management. This case report discusses a gentleman in his 60s, whose routine monitoring for proliferative diabetic retinopathy revealed the emergence of a small full-thickness macular hole, likely worsened by his complex ocular history. His ocular history included a pars plana vitrectomy combined with heavy silicone oil tamponade following a traumatic retinal detachment three years earlier, alongside pan-retinal photocoagulation, anti-vascular endothelial growth factor and steroid injections for his diabetic eye disease. Spontaneous closure of the full-thickness macular hole within three months not only improved visual acuity from 1.04 LogMAR to 0.68 LogMAR but also illustrates the retina's natural reparative capabilities. This underscores the complex aetiology of secondary full-thickness macular holes, highlighting the interplay of trauma, proliferative diabetic retinopathy, anti-vascular endothelial growth factor treatments, and prior surgeries. Observation, especially in smaller secondary holes, can be a practical approach, using the retina's natural reparative processes while avoiding surgical risks.

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