Spontaneous outer retinal closure of stage 1B macular hole without vitreofoveal separation

A 65-year-old patient complained of central metamorphopsia and presented an intraretinal cyst with a yellow ring in the fovea of the right eye. His best-corrected visual acuity was 20/32 in that eye. Optical coherence tomography (OCT) 3 showed an enlarged pseudocyst at the outer retina of a stage 1B macular hole; the foveal roof was intact where the vitreous was attached reflecting a perifoveal posterior vitreous detachment. Six months later, OCT 3 showed bridging by centripetal protrusion in the outer fovea inside the pseudocyst with a residual defect in the foveal photoreceptor layer. Eighteen months after the initial visit, spectral-domain OCT showed bridging of the outer retina inside the pseudocyst at the hyper-reflective line representing the external limiting membrane; the roof of the pseudocyst was more elevated with posterior hyaloid adhesion and there was a smaller residual defect in the foveal photoreceptor layer. This case demonstrates that spontaneous closure in the outer retina may develop in some cases of stage 1B macular holes without vitreofoveal separation.