DELAYED ONSET OF SPONTANEOUS LARGE FULL THICKNESS MACULAR HOLE CLOSURE.

Area of Science:

• Ophthalmology
• Retinal Surgery
• Macular Diseases

Background:

• Macular holes (MH) are a significant cause of vision impairment.
• Surgical intervention is the primary treatment for full-thickness macular holes (ftMH).
• Spontaneous closure of ftMH is exceptionally rare, especially after unsuccessful surgery.

Purpose of the Study:

• To report a rare case of delayed spontaneous ftMH closure.
• To explore potential new perspectives on the mechanisms of retinal hole closure.
• To highlight the importance of continued investigation into ftMH pathogenesis.

Main Methods:

• A 71-year-old female underwent 27-gauge vitrectomy for a large ftMH (460 µm).
• Surgical procedures included internal limiting membrane peeling, SF6 gas tamponade, and head-down positioning.
• The patient declined repeat surgery after initial non-closure.

Main Results:

• No MH closure was observed within 4 weeks post-surgery, with unchanged visual acuity.
• Over four years later, clinical examination and OCT revealed progressive ftMH closure.
• Visual acuity improved to 0.4 LogMAR (20/50) following spontaneous closure.

Conclusions:

• This case demonstrates that ftMH closure can occur spontaneously, even years after initial surgical failure.
• The underlying mechanisms driving spontaneous macular hole closure remain incompletely understood.
• Further research is warranted to elucidate the complex processes involved in retinal hole closure.