Surgery for macular holes associated with unusual concomitant pathologies
A 55-years-old woman, known to have RP and CME, sought an opinion concerning recent decrease in vision of the right eye. Best corrected visual acuity (BCVA) in the right eye was 20/800. Fundus examination demonstrated multiple bony spicule-like pigmentation in the mid-peripheral region. A full thickness macular hole (FTMH) 350 microns in diameter with surrounding cuff of subretinal fluid and yellowish deposits at the base, was noted in the right eye []. The left eye showed retinal pigment alterations in the macular area []. Electroretinogram in both eyes showed reduced scotopic and photopic responses []. Optical coherence tomography (OCT) showed a FTMH with cystic spaces in the right eye [] and inner lamellar defect with epiretinal membrane in the left eye [] The patient underwent 23 G pars plana vitrectomy. After posterior vitreous detachment induction, the ILM was stained with trypan blue dye (0.06%) for a contact time of 2 min. ILM peeling was carried out from arcade to arcade. Gas tamponade with C3F8 (14%) was used. The patient was advised prone positioning for 14 h/day for 2 weeks. At 2 months follow-up, visual acuity improved to 20/200. Post-operative OCT showed closure of MH with regaining of foveal contour []. However, thinning of inner segment/outer segment junction of the photoreceptors, and retinal pigment epithelial alterations were noted.