Título / Title

SPONTANEOUS RESOLUTION OF MACULAR HOLE WITH VITREO-FOVEOLAR TRACTION

Introdução / Purpose

Most spontaneous macular hole closure are related to traumatic cases. Impending macular hole considered as stage 1, may have a spontaneous resolution chance (50%). Instead, FTMH is considered a surgical condition but in restricted cases uncommon spontaneous resolution is observed in about 6% of the cases. We report a idiopathic FTMH spontaneous closure documented by SD-OCT.

Material e Método / Methods

A 67 yo female, 5-week history of central scotoma in OE. Ophthalmic exam showed BCVA of 20/40 OD and 20/200 OE, 1+ nuclear cataract on AO. Fundoscopy on OD showed no alteration, and OE a interruption of the retinal layers at the central macula region, the slit-lamp beam projected across the hole, the patient noticed a complete break (Watzke– Allen). SD-OCT showed a small (< 250 mm) Stage 2 FTMH with vitreo-foveolar traction (VFT) at the nasal edge of the operculum on the left eye. PPV for release of the VFT, ILM peel and fluid/gas exchange with 12% C3 F8 was indicated.

Resultados / Results

The patient returned after 4 months, without surgery, noticing a slight vision improvement. Ophthalmic exam showed line vision gain with BCVA 20/60 in the OE, OD was stable. New OCT showed a complete closure of the FTMH with a small defect in the ellipsoid layer and total spontaneous release of the VFT in the OE.
OCT follow-up image showed FTMH on OE remaining closed after one and three months with decrease of the ellipsoid layer defects. New OCT exam in six months is scheduled.

Discussão e Conclusões / Conclusion

Fibrous tissue proliferation and bridging after the tangential traction of the posterior hyaloid is released, may play a major role in spontaneous closure. We believe in the left eye, the posterior vitreous detachment process released the anteroposterior traction forces cessation allowing macular hole closure. We can still lead to a discussion if there is a need of ILM removal in all cases of FTMH or if the vitrectomy with release of the posterior hyaloid itself would be satisfactory in some cases.

Palavras Chave

optical coherence tomography, macular hole, vitrectomy