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Klin Monbl Augenheilkd 2025; 242(04): 445-447
DOI: 10.1055/a-2520-9568
Der interessante Fall

Long-term Follow-up of an Atypical Macular Hole Treated with 25 G Pars Plana Vitrectomy (ppV), ILM Peeling and 16% C2F6 Gas Tamponade

Langzeitverlauf eines atypischen Makulaforamens nach 25-G-Pars-plana-Vitrektomie, ILM Peeling und 16% C2F6-Gastamponade
Andreas Weinberger
1   Department of Ophthalmology, Pallas Kliniken AG, Olten, Switzerland
2   Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
,
Marko Vlasic
1   Department of Ophthalmology, Pallas Kliniken AG, Olten, Switzerland
,
Tamer Tandogan
1   Department of Ophthalmology, Pallas Kliniken AG, Olten, Switzerland
3   Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
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Introduction

Full-thickness macular holes (FTMHs) are defects in the central macula, usually involving the fovea, causing vision loss. Most FTMHs are considered to be idiopathic and caused by alterations of the vitreoretinal interface. The International Vitreomacular Traction Study Group (IVTS) defined FTMHs by optical coherence tomography (OCT) findings. A horizontal diameter at the narrowest point defined FTMHs as small (≤ 250 µm), medium (250 – 400 µm), or large (> 400 µm) [1]. Atypical macular holes are defined as macular holes secondary to trauma, dystrophy, degeneration, and similar causes. Due to the varying underlying causes, their clinical picture can vary. It is also difficult to predict the outcome of a surgical intervention. It appears that the closer the morphology of an atypical macular hole is to an idiopathic macular hole, the better the prognosis [2].

Here, we present the case of a 69-year-old female patient who presented with reduced vision in her left eye for several months. Visual acuity was 1.0 in her right and 0.25 in her left eye. The refraction was OD − 0.5 x − 0.5 axis 90° and OS + 1.25 − 0.75 axis 101°. The anterior segments were unremarkable. Examination of the posterior segments revealed some drusen in the right eye and an unusual and asymmetric FTMH in the left eye, which had a diameter of 216 micrometers (µm) at its narrowest portion and a diameter of 2172 µm at its base (0.530 mm²; [Fig. 1 a]). Due to the unusual configuration of the FTMH, we defined it as an atypical macular hole. However, we did not know the underlying pathology. The patient was last seen by another ophthalmologist two years before. We obtained the OCT from that time, which showed a minimal epiretinal membrane and a normal macular contour in the left eye.



Publication History

Received: 27 October 2024

Accepted: 15 January 2025

Article published online:
16 April 2025

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