Acute idiopathic maculopathy: report of a bilateral case manifesting a macular hole

To report an unusual patient with bilateral acute idiopathic maculopathy that was associated with a macular hole and elevated coxackievirus titers.

Observational case report.

A 30-year-old female.

A 30-year-old female with bilateral exudative maculopathy and a macular hole in the left eye was followed up with fundus photography, fluorescein angiography, and optical coherence tomography. A possible association with coxackievirus infection was evaluated. Pars plana vitrectomy in an attempt to close the macular hole also was performed.

Evolution of the maculopathy process, angiographic and optical coherence tomographic findings, and response of the macular hole to vitrectomy.

The clinical presentation and evolution of the maculopathy were most compatible with unilateral acute idiopathic maculopathy (UAIM), but with bilateral involvement. Moreover, the patient was found to have elevated coxackievirus titers at presentation. The subretinal infiltrates resolved in both eyes, with full recovery of vision in the right eye. In the left eye, the macular hole persisted despite resolution of the exudative process. Vitrectomy failed to seal the hole. We report some atypical features of this patient as they may shed light on the disease pathogenesis.

We report a patient with UAIM with bilateral involvement, a macular hole in one eye, and elevated coxackievirus titers. Macular hole formation in UAIM has not, to our knowledge, been reported.