MACULAR HOLE FORMATION AFTER VITREOMACULAR DETACHMENT WITH AN OPERCULUM

To report the detailed changes in the macular morphology documented by spectral domain optical coherence tomography in a 74-year-old woman with macular hole (MH) formation after vitreomacular detachment with an operculum.

History and clinical examinations included slit-lamp biomicroscopy, best-corrected visual acuity, color fundus photography, and spectral domain optical coherence tomography.

The patient was referred for decreased vision in the left eye (visual acuity, right eye, 20/20; left eye, 20/50). Spectral domain optical coherence tomography showed a full-thickness MH in the left eye. The right eye had a lamellar MH, and the photoreceptor inner/outer segment line was uninterrupted beneath the central fovea. The right eye had vitreomacular detachment with a small round operculum suggestive of an elevated inner foveal retina. Thirty-seven months after the initial visit, the patient returned with visual acuity in the right eye that had decreased to 20/50 and a full-thickness MH had developed in the presence of vitreomacular detachment. An epiretinal membrane appeared nasal to the fovea, and the macular surface had a triangular dimple beneath the membrane. A large retinal schisis developed nasal to the hole. A tightrope-like structure bridged the MH edges.

In this case, the MH resulted from the tangential traction caused by the epiretinal membrane after vitreomacular detachment developed; the MH was accompanied by a small round operculum, a retinal dimple beneath the membrane, and a tightrope-like structure that bridged the hole edges. The operculum likely comprised a detached inner foveal retina alone and did not include retinal photoreceptor cells.