Photoreceptor Outer Segment on Internal Limiting Membrane after Macular Hole Surgery: Implications for Pathogenesis

Area of Science:

• Ophthalmology
• Retinal Diseases
• Macular Hole Pathophysiology

Background:

• Macular holes are often attributed to anteroposterior (AP) and tangential vitreous traction on the fovea.
• Spectral domain optical coherence tomography (OCT) partially supports this, indicating AP vitreofoveal traction is more common.
• Understanding macular hole development is crucial for effective treatment strategies.

Observation:

• A 63-year-old female presented with blurred and distorted vision in her left eye.
• OCT revealed a macular hole with persistent vitreofoveal attachment.
• Electron microscopy of the internal limiting membrane (ILM) showed a photoreceptor outer segment on the retinal side.

Findings:

• The patient underwent surgery including ILM peel and gas injection.
• Post-operative OCT confirmed hole closure with foveal contour recovery and improved vision.
• The presence of a photoreceptor outer segment on the ILM highlights novel aspects of macular hole etiology.

Implications:

• This case underscores the role of tangential traction in certain macular hole developments.
• It supports the theory of force transmission to photoreceptors via Müller cells.
• The findings suggest macular holes can form without significant AP vitreomacular traction.