PMC3913987_01
(A) A fundus photograph of the left eye shows a dome-shaped sub-internal limiting membrane (ILM) hemorrhage (white asterisk) and a sub-hyaloid hemorrhage located anterior and inferotemporal to the sub-ILM hemorrhage (white cross) at initial presentation. Note the "double ring" sign with the "inner ring" caused by the sub-ILM hemorrhage and the "outer ring" caused by the sub-hyaloid hemorrhage. (B) After four weeks, a fundus photograph showed spontaneous absorption of the sub-hyaloid hemorrhage, but the sub-ILM hemorrhage remained. (C) After nine weeks, the sub-ILM and sub-hyaloid hemorrhages were almost completely resolved, and a focal yellowish lesion was observed on the fovea. (D) The Time-domain optical coherence tomography (OCT) at the initial presentation revealed a premacular hemorrhage with hyperreflective ILM (white arrowhead) and a hyporeflective sub-hyaloid membrane (white arrow). The foveal contour was intact (double arrow). (E) After four weeks, OCT showed resolution of the premacular hemorrhage with a thick preretinal membrane. (F) After nine weeks, the premacular hemorrhage was completely resolved, but a hyperreflective, thick preretinal membrane (white arrowhead) remained.
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F1
Time-domain OCT (TD-OCT) revealed an intact foveal contour and two membranes of differing optical reflectivity, identified as the internal limiting membrane (ILM) and the posterior hyaloid, respectively, with blood beneath the hyperreflective membrane (Fig. 1). Yellowish residual sub-ILM deposits, however, were present, and a thick preretinal membrane was visible over the fovea (Fig. 1).
Serial spectral domain-optical coherence tomography images before and after pars plana vitrectomy. The macular hole was not identified immediately after the first operation but was observed after resolution of the sub-internal limiting membrane deposits at two weeks after the first surgery. (A) Before 1st operation, (B) 1 day after 1st operation, (C) 4 day after 1st operation, (D) 7 day after 1st operation, (E) 14 day after 1st operation, and (F) 14 day after 2nd operation.
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F2
Postoperative SD-OCT, which was used to analyze the cross-sectional image almost every day (Fig. 2), did not reveal an MH during the first seven days.
(A,B) Fundus photograph and spectral domain-optical coherence tomography (SD-OCT) images after the initial pars plana vitrectomy. SD-OCT revealed hemosiderin-like deposits (arrowhead) of the fovea. (C,D) Fundus photograph and SD-OCT images before secondary pars plana vitrectomy. SD-OCT showed a full-thickness macular hole. (E,F) Six months after the second surgery, the macular hole was completely closed with minimal scarring of the photoreceptor inner/outer segment junction (arrow), as determined by SD-OCT.
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F3
SD-OCT showed that the MH had closed with only slight scarring of the photoreceptor inner segment/outer segment junction (Fig. 3).