Persistent Full-Thickness Macular Hole secondary to Central Bouquet Hemorrhage in Pathologic Myopia: A Case Report

To discuss the case of an 82-year-old man with high myopia who developed a full-thickness macular hole (FTMH) following the spontaneous resolution of a central bouquet hemorrhage (CBH) associated with a lacquer crack.

The patient initially presented with a central scotoma in the right eye, with optical coherence tomography (OCT) showing the presence of CBH. The patient was closely monitored with noninvasive retinal imaging.

Over five months, the CBH gradually reabsorbed, yet vertical hyperreflective lines and disruption of the ellipsoid zone persisted in the foveal area on follow-up OCT scans. Approximately three years after the reabsorption of the hemorrhage, the patient developed a FTMH, despite OCT scans showing no significant vitreomacular traction. The FTMH was treated with vitrectomy and gas tamponade injection, resulting in persistent MH after two vitreoretinal surgeries.

We hypothesize that Müller cell dysfunction, induced by the CBH, may have played a crucial role in the central cleavage that led to the FTMH formation. Given the prolonged interval between the CBH and FTMH development, this case underscores the need for further longitudinal studies to investigate the long-term outcomes of CBHs and the possible association with FTMH formation.