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Bilateral Simultaneous Full-Thickness Macular Holes: A Case Report with Spontaneous Resolution.

Isabel López-Bernal1, Ángel Sánchez Trancón1, Pedro Serra1

  • 1Ophthalmology Clinic Vista Sánchez Trancón, 06010 Badajoz, Spain.

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|July 25, 2025
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Summary

Small macular holes (<250 µm) can close spontaneously, restoring vision. This case study supports a conservative, observational approach for select patients, potentially avoiding surgery for full-thickness macular holes.

Keywords:
bilateralmacular holeoptical coherence tomographyspontaneous closure

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Area of Science:

  • Ophthalmology
  • Retinal Diseases

Background:

  • Full-thickness macular hole (FTMH) affects detailed vision, often idiopathic.
  • Small FTMH (<250 µm) may close spontaneously, but management is debated.
  • Surgical intervention is common for larger holes, but spontaneous closure occurs in ~25% of small holes.

Observation:

  • A 65-year-old female patient with bilateral FTMH was monitored via spectral domain optical coherence tomography (OCT).
  • Vitreomacular traction was identified as the cause of hole formation.
  • Spontaneous closure of both macular holes was observed, with associated visual acuity recovery.

Findings:

  • Spontaneous closure of small FTMH (<250 µm) is possible.
  • OCT imaging revealed bridging as the mechanism for spontaneous closure.
  • Visual acuity improved following spontaneous anatomical closure.

Implications:

  • This case supports a conservative, observational strategy for select small FTMH.
  • Non-surgical management may be appropriate, avoiding unnecessary interventions.
  • Understanding spontaneous closure mechanisms can guide clinical decision-making for macular hole treatment.