PMC9954153_01
Widefield fundus imaging of the (A) right eye and (B) left eye shows a
myopic-appearing fundus with tilted discs and peripapillary atrophy
extending into the nasal macula in both eyes. The vessels in both eyes
appear normal. The macula shows attenuated pigmentation consistent with
posterior staphyloma as well as discrete foci of chorioretinal atrophy with
some pigment clumping nasal to the disc in both eyes, suggestive of myopic
degeneration.
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Fundus examination showed bilateral macular posterior staphyloma with tilted discs and peripapillary atrophy in both eyes (Figure 1, A and B).
Spectral-domain optical coherence tomography line scans through the macula at
initial presentation, confirming the presence of posterior staphyloma and
myopic foveoschisis as well as epiretinal membranes in the (A) right eye and
(B) left eye. No vitreomacular traction was present in the left eye.
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Spectral-domain OCT of the macula confirmed the presence of a posterior staphyloma, myopic foveoschisis, and a mild epiretinal membrane (ERM) in both eyes (Figure 2, A and B).
Spectral-domain optical coherence tomography line scans through the macula in
the left eye 1 month after initial presentation show (A) evidence of
subfoveal fluid extending into the nasal parafovea as well as a shallow
underlying pigment epithelial detachment with subretinal hyperreflective
material corresponding to the submacular hemorrhage. These findings are
characteristic of myopic choroidal neovascularization. (B) This scan shows a
stage 2 full-thickness macular hole with underlying subretinal
hyperreflective material.
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Subretinal fluid and hemorrhage were identified on examination, and fluid as well as subretinal hyperreflective material (SHRM) was seen on OCT imaging of the left eye (Figure 3A). A small full-thickness MH (diameter 86 microm) was also noted on OCT (Figure 3B).
Spectral-domain optical coherence tomography of the macula in the left eye 1
month after 2 intravitreal aflibercept injections shows resolution of the
subretinal hyperreflective material and a larger stage 3 full-thickness
macular hole with progressed foveal dehiscence.
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However, interval enlargement to a medium full-thickness MH (diameter 287 microm) and worsening foveal dehiscence were now seen (Figure 4).
Spectral-domain optical coherence tomography macula of the left eye 1 month
after the second procedure (pars plana vitrectomy with internal limiting
membrane autologous transplantation) shows successful closure of the
full-thickness macular hole.
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BCVA was 20/150 and there was a visually significant cataract (Figure 5). By 3 months postoperatively, the MH had not reopened and the CNV had not recurred.