Spontaneous Disappearance and Recurrence of Impending Macular Hole

journal of medical case reports
18 Nov, 2019 ,

A 76-year-old Japanese man presented with a primary complaint of reduced visual acuity in his right eye. On initial examination, the visual acuity in his right and left eye was 0.4 and 0.01, respectively. He had previously been diagnosed as having macular degeneration of unknown origin in his left eye. Optical coherence tomography imaging confirmed vitreomacular traction and impending macular hole in his right eye. After a 1-week follow-up period, posterior vitreous detachment was detected, and the impending macular hole appeared to be resolved. Two months later, the impending macular hole had completely disappeared and his visual acuity had improved to 0.9. Six months later, he again noticed decreased vision in his right eye. An examination revealed that his visual acuity had dropped to 0.4, and there was a recurrence of impending macular hole. An optical coherence tomography examination showed no definitive findings of vitreous traction, and, 1 month later, spontaneous disappearance was observed again and his visual acuity improved to 0.7.

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A 76-year-old Japanese man presented with the primary complaint of decreased visual acuity (VA) in his right eye. Fifty years previously, he had been diagnosed as having macular degeneration of unknown origin in his left eye, yet no particular systemic diseases were found. In February 2017, he became aware of decreased vision in his right eye, and subsequently presented at our hospital on March 16, 2017. He had no particular past medical, social, environmental, family, or employment history of interest. Moreover, he was not receiving any medications and there were no lifestyle-related habits such as tobacco smoking and/or alcohol consumption prior to initial presentation. On examination, his uncorrected VA (UCVA) was 0.4 in his right eye and 0.01in his left eye, and the intraocular pressure in his right and left eyes was 10 mmHg and 11 mmHg, respectively.

Both eyes were emmetropic; the axial length in his right eye was 23.62 mm, while that in his left eye was 23.25 mm. There were no abnormal findings in the anterior segment, even though he had a mild cataract in the ocular media. Optical coherence tomography (OCT) imaging revealed vitreous traction in the fovea centralis of his right eye. Moreover, foveal retinal detachment and cystic formation were observed, yet the retinal inner layer continued in a bridge shape, thus signifying IMH (that is, a stage 1B MH). In addition, chorioretinal atrophy was observed in his left eye. At the time of admission, there were no abnormalities in the physical and neurological examinations including pulse, blood pressure, and temperature. Laboratory findings, including complete blood count (CBC), liver and renal functions, and urine analysis, also revealed no abnormalities. With the consideration of a possible spontaneous remission, we decided to perform scheduled follow-up examinations.

At the initial follow-up examination performed 1 week later, the UCVA in his right eye was found to have improved to 0.6, and an OCT imaging revealed that the vitreous traction in the fovea centralis had disappeared and that the cystic formation had been reduced, leaving only retinal detachment in the fovea centralis (Fig. 2). It should be noted that even though we did not perform fluorescein angiography, there were no obvious abnormalities of the retinal pigment epithelium in his right eye at that time.

Optical coherence tomography images obtained 1 week after the initial visit showing that the vitreous traction in the fovea centralis had disappeared and that the cystic formation had reduced, leaving only retinal detachment in the fovea centralis

Two months later, his UCVA had improved to 0.9 and the retinal detachment in the fovea centralis had resolved. Moreover, we were able to confirm the line of the inner segment/outer segment. On November 16, 2017, approximately 6 months post confirmation of the spontaneous remission, he again became aware of decreased VA in his right eye, and returned to our hospital. The UCVA in his right eye had decreased to 0.4 and OCT findings revealed cystic formation around the fovea centralis, as well as a recurrence of the fovea retinal detachment.

Although we speculated an IMH, there was no clear evidence of vitreous traction. We did not perform fluorescein angiography; however, it should be noted that there were still no obvious abnormalities of the retinal pigment epithelium in his right eye. A follow-up examination conducted on December 28, 2017 (1 month later) revealed that the UCVA in his right eye had improved to 0.7. In addition, OCT findings revealed improvements in both the cyst formation around the fovea centralis and the fovea retinal detachment without any treatment. A follow-up examination performed on February 22, 2018 (2 months later) revealed that the UCVA in his right eye had improved to 0.8.