PMC5088457_01
Fluorescein angiography (FA) and optical coherence tomography (OCT) images from a patient with a macular hole following acute uveitis in Vogt-Koyanagi-Harada syndrome. Preoperative (figures a-d) and postoperative images (e-h). a An early-phase FA image shows hyperfluorescence suggestive of retinal pigment epithelial (RPE) defects. b A late-phase FA image shows diffuse hyperfluorescence at the optic disc suggestive of persistent uveitis. c The position of the OCT scan at the macula. d An OCT image shows the macular hole (MH). A serous detachment of the macula is nasal to the fovea. e an early-phase postoperative FA image shows minimal hyperfluorescence suggestive of RPE defects. f A late-phase postoperative FA image shows diffuse hyperfluorescence at the optic disc suggestive of persistent uveitis less relevant than preoperatively. g The position of the OCT scan at the macula. h A postoperative OCT scan shows MH closure. No serous detachment of the macula is observed
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Fig1
FA showed decreased hyperfluorescence at the foveal region (Fig. 1e, f), OCT showed resolution of the MH and a retinal thickness of about 183 microns (Fig. 1g, h) and the BCVA remained stable after at least 1 year postoperatively with titrating of topical steroids and oral prednisone (initially at 1 mg/kg/day).
Macular hole surgery images. a Posterior hyaloid detachment guided by deposition of 40 mg/ml of triamcinolone acetonide and internal limiting membrane (ILM) peeling guided by injection of 0.50 mg/ml of brilliant blue. b ILM peeling after staining with Brilliant Blue. The ILM adheres tightly to the neurosensory retina. c The final stage of ILM peeling. The image shows the size of the MH and the peeled ILM around the MH. d Fluid-air exchange. Subretinal fluid resembling honey is drained through the MH that is likely related to subretinal fibrin collection due to the uveitis
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Fig2
ILM peeling was guided by 0.5 mg/ml of Brilliant Blue (Ophthalmos, SP, Brazil) staining (Fig. 2a-c) and it was observed to be tightly adhered to the neurosensory retina during peeling. A small macular detachment was present and fluid-air exchange was performed with aspiration of the subretinal thick fluid through the MH (Fig. 2d).