Second Spontaneous Opening and Closing of a Macular Hole Associated With High Altitude Following Pars Plana...

A 60-year-old male with macula-off rhegmatogenous retinal detachment (RRD) underwent pars plana vitrectomy (PPV) in 2020. After surgery, the patient lived for several months in a high-altitude region (average altitude: 2,500 m/8,202 ft). One year later, optical coherence tomography (OCT) revealed a spontaneously formed full-thickness macular hole (FTMH), along with perifoveal cystoid changes and an epiretinal membrane (ERM). The patient stayed in Nanchang (average altitude of about 24 m/78.74 ft) over the following year, and the macular hole (MH) closed spontaneously, accompanied by an improvement in visual acuity. However, in 2023, when the patient returned to the high-altitude region, the MH reappeared. A second spontaneous closure was observed one year later. Multiple mechanisms may contribute to the formation and closure of MHs after vitrectomy. Given these mechanisms, and the spontaneous closure twice observed in this patient, a conservative approach may be warranted - especially when cystoid changes and minimal traction are present. This differs from the traditional approach of immediate surgical intervention and suggests that individualized patient factors should be considered when making treatment decisions.