PMC6358394_01
Optical coherence tomography (OCT) and fluorescein angiography (FA) images of the eye with recurrent macular holes with spontaneous closures over time. Vertical OCT images (A-H) at the time of 4 episodes of macular hole formation (A, C, E, G), and of closure and inclosing (B, D, F, H). Perifoveal cystoid change and retinal protrusion were observed at every episode of macular hole formation (A, C, E, G). The bridging element was obvious in the last episode (H, arrow). The macular hole was closed with (B and F) or without (D and H) pars plana vitrectomy. The FA images (I and J) showed diffuse inflammation in the whole retina. Compared with the FA image recorded on the same day as the OCT image-(H) (I), inflammation was partially reduced by topical steroid administration after 3 months (J). A recent vertical OCT image shows complete closure of the macular hole (K). Best-corrected visual acuity in decimal (logMAR) at each time point was (A) 0.3 (0.52 in logMAR) in March 2013, (B) 1.2 (-0.079) in June 2013, (C) 1.0 (0.0) in August 2015, (D) 1.2 (-0.079) in September 2015, (E) 0.7 (0.15) in February 2017, (F-H) 1.0 (0.0) in April, July, and August, 2017, respectively, (I) the same day as (H), and August 2017, (J) 1.0 (0.0) in November 2017, and (K) 1.2 (-0.079) in July 2018.
medi-98-e14230-g001.jpg
PMC6358394_01_medi-98-e14230-g001.jpg
F1
She underwent PPV with internal limiting membrane (ILM) peeling to remove tractional forces at the vitreoretinal interface and SF6 gas tamponade, following cataract surgery with intraocular lens implantation as usual in June 2013; practical closure of the macular hole and recovery of BCVA were achieved (Fig. 1B). In August 2015, she presented with a recurrent macular hole (Fig. 1C). The PPV was planned; however, it was cancelled because spontaneous closure was achieved by September 2015 (Fig. 1D). In February 2017, she presented with the 2nd recurrent macular hole (Fig. 1E) and underwent a 2nd PPV procedure; no residual ILM was found in the macula, despite the use of staining; tamponade was performed with C3F8 gas to obtain an extended effect. The macular hole was closed by April 2017 (Fig. 1F). Subsequently, she was diagnosed with the 3rd recurrent macular hole (Fig. 1G), which was closing spontaneously (Fig. 1H). The FA showed microvascular inflammation in the peripheral retina in her right eye in August 2017 (Fig. 1I). Topical steroid administration was restarted and the inflammation was partially resolved in November 2017 (Fig. 1J). The symptom had disappeared, and the macular hole remained closed at the time of her last visit (Fig. 1K). Perifoveal cystoid changes surrounding the macular hole that were recorded by OCT images in every macular hole recurrence (Fig. 1A, C, E, G), were subsequently resolved at the time of closure during 5 years and 5 months of follow up period (Fig. 1B, D, F, H). During the 4th closure, a bridging element was observed (Fig. 1H arrow).