Document Detail

Spontaneous closure of stage IV idiopathic full-thickness macular hole and late reopening as a lamellar macular hole: a case report.
Jump to Full Text
MedLine Citation:
PMID:  22742449     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Spontaneous closure of traumatic macular holes is described as a common event in the peer-reviewed literature. However, the spontaneous closure of stage III and IV full-thickness idiopathic macular holes has been reported in less than 15 cases in the literature, this being an extremely rare event, with their reopening being even more infrequent. We report a case of a spontaneous closure of stage IV idiopathic full-thickness macular hole and late reopening as a lamellar macular hole.
CASE PRESENTATION: A 67-year-old Spanish man was referred to our hospital with a complaint of decreased vision in his right eye and metamorphopsia for approximately 11 months. He did not report any trauma. Diagnosis was based on fundoscopic and optical coherence tomography. They revealed a stage IV full-thickness idiopathic macular hole and a small epiretinal membrane. Three months later the hole spontaneously closed, and two years later we appreciated its reopening as a lamellar macular hole.
CONCLUSIONS: The contraction of the epiretinal membrane could have contributed to cystic spaces and their fusion, subsequently, to the formation of a lamellar macular hole. To the best of our knowledge this is the first report in the literature of a spontaneously closed full-thickness idiopathic macular hole with reopening as a partial thickness macular defect.
Authors:
Miriam García Fernández; Joaquín Castro Navarro
Related Documents :
22935949 - Analysis of 16 years of homicides and suicides involving the use of weapons recorded at...
14590999 - Neuropsychological assessment and malingering: a critical review of past and present st...
20531059 - Starvation causes acute psychosis due to anterior thalamic infarction.
22276029 - Metachronous bladder metastases from renal cell carcinoma: a case report and review of ...
22674099 - Transient foreign accent syndrome.
22541779 - Mixed schwannoma with meningioma - report on 2 cases of unusual tumor with review of li...
9844769 - Dermatomyositis with subclinical myositis and spontaneous pneumomediastinum with pneumo...
10959659 - Salmonella virchow meningitis in an adult.
14615259 - Cryogenic burns from aerosol sprays: a report of two cases and review of the literature.
Publication Detail:
Type:  Journal Article     Date:  2012-06-28
Journal Detail:
Title:  Journal of medical case reports     Volume:  6     ISSN:  1752-1947     ISO Abbreviation:  J Med Case Rep     Publication Date:  2012  
Date Detail:
Created Date:  2012-08-03     Completed Date:  2012-10-02     Revised Date:  2014-07-14    
Medline Journal Info:
Nlm Unique ID:  101293382     Medline TA:  J Med Case Rep     Country:  England    
Other Details:
Languages:  eng     Pagination:  169     Citation Subset:  -    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): J Med Case Rep
Journal ID (iso-abbrev): J Med Case Rep
ISSN: 1752-1947
Publisher: BioMed Central
Article Information
Download PDF
Copyright ©2012 García Fernández and Castro Navarro; licensee BioMed Central Ltd.
open-access:
Received Day: 9 Month: 1 Year: 2012
Accepted Day: 28 Month: 6 Year: 2012
collection publication date: Year: 2012
Electronic publication date: Day: 28 Month: 6 Year: 2012
Volume: 6First Page: 169 Last Page: 169
ID: 3410762
Publisher Id: 1752-1947-6-169
PubMed Id: 22742449
DOI: 10.1186/1752-1947-6-169

Spontaneous closure of stage IV idiopathic full-thickness macular hole and late reopening as a lamellar macular hole: a case report
Miriam García Fernández1 Email: migarci@hotmail.es
Joaquín Castro Navarro1 Email: jcastro22557@gmail.com
1Department of Opthalmology, Central University Hospital of Asturias, Oviedo, Asturias, Spain

Introduction

The macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea. There exists controversy regarding the pathogenesis, prognosis and treatment of this condition.

Spontaneous closure of traumatic macular holes is described as a common event in the peer-reviewed literature. However, the spontaneous closure of stage III and IV idiopathic macular holes has been reported in less than 15 cases in the literature, this being an extremely rare event [1-8]. Furthermore, there are only two reports about spontaneous reopening of a spontaneously closed macular hole [9,10].

However, to the best of our knowledge, there are no papers describing the reopening as a lamellar macular hole after a long-standing spontaneous closure of a full-thickness macular hole (FTMH).


Case presentation

A 67-year-old Spanish man with unremarkable ocular and systemic history, except for a depressive syndrome, was referred to our hospital. He presented with decreased vision in his right eye and a history of metamorphopsia for approximately 11 months. He did not report any trauma. His best-corrected visual acuity (BCVA) was 0.5 in the right eye and 1.0 in the left eye.

Anterior segment examination revealed a bilateral nuclear sclerosis with no further abnormalities. Fundoscopy revealed an image of a full-thickness macular hole. Optical coherence tomography (OCT) examination (Figure 1a) showed a stage IV FTMH according to its size (more than 400 μ) and according to the posterior vitreous detachment, the latter only visible on fundoscopy examination.

We also appreciated some cystic spaces on both edges of the hole, and a small epiretinal membrane (ERM). We observed clear irregularity of the junction of inner and outer segments of photoreceptors (IS/OS).

Three months later, his BCVA had not improved. OCT scans revealed a closed macular hole. We observed an elevation of the photoreceptor layer and of the external limiting membrane (ELM) over a cystic space, and a defect in the continuity of the photoreceptor layer (Figure 1b).

Seven months later, his BCVA remained the same. An OCT examination showed the disappearance of the cystic space, and a normal foveal contour (Figure 2a).

At 13 months later, his BCVA improved to 0.7. An OCT scan showed no changes (Figure 2b).

Two years later, his BCVA remained unchanged but on OCT scan we surprisingly observed a lamellar macular hole (Figure 3), according to the Haouchine [11] criteria: irregular thinning of foveal base, break in the inner fovea, intra-retinal split (dehiscence of the inner foveal retina from the outer retina), normal perifoveal retinal thickness and absence of a full-thickness foveal defect.


Discussion

The spontaneous closure of idiopathic macular holes is less prevalent and less well understood than closure of traumatic macular holes [4].

Several mechanisms for the spontaneous closure of idiopathic macular holes have been described: a complete detachment of the posterior hyaloids, leading to a reduction in antero-posterior tractional forces [7]; the bridging effect of retinal tissue and glial cell proliferation across the hole [5,8,9]; and the formation of a contractile ERM, which provokes shrinkage of the hole, and the cells proliferation at its base [12].

There are reported cases of spontaneous closure of FTMH in one eye after vitreoretinal surgery for FTMH in the other eye. In these cases, the prone position and gravitational forces involved can determine the complete detachment of the posterior vitreous, releasing the forces that contribute to FTMH progression [2,3].

In our patient, we think that it is likely a vitreomacular traction started the formation of the FTMH. After that, a vitreous posterior detachment occurred, and, as the antero-posterior tractional forces released, the macular hole began to close.

The first time we observed our patient, the opening diameter of the hole was over six times smaller than the basal diameter; this may have been due to the fact that the restoration had already begun.

Three months later, the process of closure continued, and the bridging effect started. Several authors consider this as the first step in macular hole closure [5,8,9].

Six months later (three months after the observation of the bridging effect) we were able to observe the complete closure of the macular hole.

Despite this, our patient’s BCVA did not improve to 1.0. It is likely that the disruption in the photoreceptor layer had resulted in worse visual acuity.

Interestingly, three months is also the time required to the definitive closure since the starting of the bridging effect, in other similar report in the literature [8].

There are two distinct features of our patient. Firstly, the relatively old age for the spontaneous closure, and secondly, which is more relevant, the formation of a lamellar macular hole one year after the closure (and two years since the development) of the FTMH, this being, to the best of our knowledge, the first case reported in the peer-reviewed literature.

Several factors have been described for the reopening of full-thickness macular holes after vitrectomy: cataract extraction (although controversial) [13], neodymium: yttrium aluminum garnet (YAG) capsulotomy [14], tangential contraction of an ERM [15], and so on. However, the pathogenesis of spontaneous reopening is still controversial.

In the case of the tangential contraction of an ERM, the mechanism is the formation of intra-retinal cysts and their posterior rupture and fusion. This cystoid macular edema (CME) can also be secondary to age-related macular degeneration, diabetic retinopathy, inflammatory and vascular diseases, and so on.

These factors could be also valid for lamellar macular holes, considering the fact that lamellar holes are described as an abortive process in the development of FTMH formation.


Conclusions

To the best of our knowledge, this is the first case in the peer-reviewed literature that describes the late evolution of a spontaneously closed full-thickness macular hole to a lamellar macular hole.

In our patient, the mechanism of formation of a lamellar macular hole after spontaneous closure of a stage III to IV idiopathic macular hole remained unanswered.

We postulate that, considering the absence of any surgery, inflammatory or vascular diseases during the follow-up, the antero-posterior traction of the small epiretinal membrane, and consequently, the formation of intra-retinal cysts, with posterior rupture and fusion, might have played a role in the development of the lamellar macular defect.

In those cases of spontaneously closed FTMH with associated ERM, we may consider periodic observation as the progression of the ERM can contribute to the formation of a lamellar macular hole, which, although infrequently, could progress to a new FTMH.


Consent

Written consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.


Competing interests

The authors declare that they have no competing interests.


Authors’ contributions

MGF was involved in data acquisition and manuscript drafting. JCN was involved in data interpretation and revised the report critically for important intellectual content. All authors read and approved the final manuscript.


References
Scassa C,Bruno M,Ripandelli G,Giusti C,Scarinci E,Cupo G,Spontaneous closure of bilateral full-thickness macular holes without surgery: an eleven-year follow-upEur Rev Med Pharmacol SciYear: 20111571772021796877
Win PH,Young TA,Spontaneous macular hole closure in bilateral macular holesSemin OphthalmolYear: 20072216716910.1080/0882053070150098217763238
Michalewska Z,Cisiecki S,Sikorski B,Michalewski J,Kałuzny JJ,Wojtkowski M,Nawrocki J,Spontaneous closure of stage III and IV idiopathic full-thickness macular holes-a two case reportGraefes Arch Clin Exp OphthalmolYear: 20082469910417653749
Schweitzer KD,García R,Spontaneous closure of a stage III idiopathic macular holeCan J OphthalmolYear: 20074212712817361255
Milani P,Seidenari P,Carmassi L,Bottoni F,Spontaneous resolution of a full thickness idiopathic macular hole: fundus autofluorescence and OCT imagingGraefes Arch Clin Exp OphthalmolYear: 20072451229123110.1007/s00417-006-0530-017235599
Punjabi OS,Flynn HW,Legarreta JE,Gregori G,Puliafito CA,Documentation by spectral domain OCT of spontaneous closure of idiopathic macular holesOphthalmic Surg Lasers ImagingYear: 20073833033217674926
Ishida M,Takeuchi S,Okisaka S,Optical coherence tomography images of idiopathic macular holes with spontaneous closureRetinaYear: 20042462562810.1097/00006982-200408000-0002415300092
García-Pous M,Udaondo-Mirete P,Amselem-Gómez L,Salom-Alonso D,Cervera-Taulet E,García-Delpech S,Díaz-Llopis M,Spontaneous resolution of idiopathic macular hole type IV: optical coherence tomography follow-upArch Soc Esp OftalmolYear: 20068122923216688649
Kokame GT,McCauley MB,Spontaneous reopening of a spontaneously closed macular holeAm J OphthalmolYear: 200213328028210.1016/S0002-9394(01)01306-X11812442
Park YH,Kim SY,Lee YC,Macular hole formation, spontaneous closure, and reopening in severe hypertensive chorioretinopathyClin Experiment OphthalmolYear: 20073558658810.1111/j.1442-9071.2007.01538.x17760645
Haouchine B,Massin P,Tadayoni R,Erginay A,Gaudric A,Diagnosis of macular pseudoholes and lamellar macular holes by optical coherence tomographyAm J OphthalmolYear: 200413873273910.1016/j.ajo.2004.06.08815531306
Lewis H,Cowan GM,Straatsma BR,Apparent disappearance of a macular hole associated with development of an epiretinal membraneAm J OphthalmolYear: 198610217217510.1016/0002-9394(86)90139-X3740176
Bhatnagar P,Kaiser PK,Smith SD,Meisler DM,Lewis H,Sears JE,Reopening of previously closed macular holes after cataract extractionAm J OphthalmolYear: 200714425225910.1016/j.ajo.2007.04.04117543876
García-Arumí J,Palau MM,Espax AB,Martínez-Castillo V,Garrido HB,Corcóstegui B,Reopening of 2 macular holes after neodymium:YAG capsulotomyJ Cataract Refract SurgYear: 20063236336610.1016/j.jcrs.2005.07.02016565020
Yoshida M,Kishi S,Pathogenesis of macular hole recurrence and its prevention by internal limiting membrane peelingRetinaYear: 20072716917310.1097/01.iae.0000224940.79223.fb17290198

Figures

[Figure ID: F1]
Figure 1 

Cirrus optical coherence tomography (OCT) scan. (a) Scan at first visit, showing a stage IV full-thickness idiopathic macular holes (FTMH). The basal and minimal macular hole diameters were 460 μ and 60 μ, respectively. Clear irregularity of the junction of inner and outer segments of photoreceptors (IS/OS) and a small epiretinal membrane (ERM) can be observed. (b) Scan at the third month follow-up visit, revealing a closed macular hole, and a cystic space that represents the bridging effect. A disruption of the photoreceptor layer can also be appreciated. The basal diameter of the cystic space is 464 μ, and the height of the elevation 124 μ.



[Figure ID: F2]
Figure 2 

Cirrus optical coherence tomography (OCT) scan. Scans from the seventh-month (a) and 13th-month (b) follow-up visits, respectively, showing the disappearance of the cystic space, and a normal foveal contour, although a small interruption in the line corresponding to the photoreceptors (IS/OS) and in the external limiting membrane (ELM) can be appreciated.



[Figure ID: F3]
Figure 3 

Cirrus optical coherence tomography (OCT) scan. Two years later, we observed a lamellar macular hole, according to the Haouchine criteria. However, we appreciated damage to the photoreceptors, which does not usually appear in lamellar macular holes.



Article Categories:
  • Case Report

Keywords: Macular hole, spontaneous closure, lamellar macular hole.

Previous Document:  Effect of human beta-defensin-3 on head and neck cancer cell migration using micro-fabricated cell i...
Next Document:  Human YKL-39 is a pseudo-chitinase with retained chitooligosaccharide-binding properties.