DELAYED ONSET OF SPONTANEOUS LARGE FULL THICKNESS MACULAR HOLE CLOSURE

Reporting this rare case of spontaneous delayed-onset full-thickness macular hole closure after unsuccessful initial surgical treatment encourages to have new perspectives on the mechanism behind this retinal process.

Uneventful 27-gauge vitrectomy was performed in a 71-year-old female patient for large (460 μm) macular hole. The surgery was combined with peeling of the internal limiting membrane, SF6 tamponade, and head down positioning for 3 days. No closure of the MH was detected within 4 weeks after surgery and visual acuity remained unchanged. The patient refused a revitrectomy.

More than 4 years after surgery, a progressive closure of the macular hole was detected clinically and on optical coherence tomography with recovery of vision to 0.4 logarithm of the minimum angle of resolution (20/50).

This rare case shows that full mechanisms of macular hole closure yet remain unclear and need to be studied further.