SPONTANEOUS CLOSURE AND RECURRENT OPENING TIMES TWO OF A MACULAR HOLE IN A SURGICALLY NAIVE EYE

To report a case of an idiopathic macular hole with recurrent opening and spontaneous closure in a surgically naive eye.

A retrospective review of medical records was performed in addition to a review of the current literature.

An 82-year-old man was referred for the management of a full-thickness macular hole in the right eye. Visual acuity was 20/60, and dilated fundus examination was notable for a posterior vitreous detachment, macular hole, and mild epiretinal membrane. Optical coherence tomography confirmed the presence of a full-thickness macular hole. The patient declined surgical intervention and elected to observe. Five weeks later, optical coherence tomography confirmed spontaneous closure. One year later, a recurrent partial thickness outer retinal hole was noted on dilated fundus examination and optical coherence tomography that subsequently spontaneously closed for the second time. The following year, the patient represented with a new scotoma and metamorphopsia and was found to have a full-thickness macular hole. This time the patient was elected for surgical intervention (25-gauge pars plana vitrectomy, epiretinal membrane peel, and 14% C3F8), resulting in closure of the macular hole and improvement in visual acuity to 20/25+1.

This case highlights a rare presentation of a see-saw pattern of opening and closing of a macular hole in a treatment-naive eye. The presence of a posterior vitreous detachment and epiretinal membrane suggests that other factors than anterior-posterior and tangential traction may be a contributing in the formation and closure of idiopathic macular holes.