Hyperautofluorescent ring in eyes with macular holes
A 62-year-old woman was referred to our department with a diagnosis of MH in her left eye. She had not noticed the decrease in her central vision until it was pointed out by an optometrist. At presentation, her decimal best-corrected visual acuity (BCVA) was 1.0 in the right eye and 0.08 in the left eye. Fundus photographs and fundus autofluorescence images were taken with the Optos® 200Tx (Optos, Scotland, United Kingdom), and optical coherence tomography was performed with the Cirrus™ HD OCT (Carl Zeiss Meditec Japan, Tokyo, Japan). The left eye had a large MH with an operculum ( and ). The minimal and maximal diameters of the MH were 864 μm and 1,345 μm, respectively, and a depigmented ring was observed surrounding the area of the fluid cuff ( and ). Fundus autofluorescence showed a hyperautofluorescent ring corresponding to the depigmented ring ( and ).\nCombined phacoemulsification and vitrectomy with a 25-gauge system was performed on the left eye under local anesthesia. Core vitrectomy following the creation of posterior vitreous detachment was performed with an ultrahigh-speed cutter (5,000 cycles per minute, Alcon Laboratories Inc, Fort Worth, TX, USA). The internal limiting membrane was stained with 0.025% Brilliant Blue G and peeled within the vascular arcade. The peripheral retina was examined for 360 degrees with scleral indentation to search for any retinal breaks. The vitreous cavity was filled with 20% sulfur hexafluoride, and the patient was instructed to maintain a prone position for as long as possible.\nAn anatomic closure of the MH was not achieved. She did not want any additional treatment, and the MH remained open for 6 months after the vitrectomy ( and ). Fundus autofluorescence at this time showed the same size hyperautofluorescent ring as the preoperative one in spite of a decrease in the postoperative size of the opened MH (). The decimal BCVA of the left eye 6 months after the vitrectomy was poor at 0.08.