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Case 3-14* Stage 4 Macular Hole with Operculum

Clnical Summary

A 58-vear-old woman was evaluated for decreasing vision in her right eye over a period of a yean Her visual acuitv in this eye was counting fingers at 7 feet. Slit-lamp biomicroscopy (A) revealed a full-thickness macular hole and a cuff of subretinal fluid- A posterior vitreous detachment was observed and a mild epiretinal membrane was noted surrounding the hole. Fluorescein angiography (B) demonstrated stable hyperfiuorescence in the center of the macula consistent with a window defect. A faint rim of hyperfiuorescence surrounding the fovea was observed in later views consistent with macular edema.

Optical Coherence Tomography

An OCT image (C) through the macula and optic disc showed a 540 jam diameter full-thickness defect in the neurosensory retina. Reduced optica! reflectivity corresponding to fluid accumulation and cystic changes was evident in the outer retinal layers surrounding the hole. The pos~ terior vitreous was separated from both the macula and optic disc by about 300 to 500 \im in the tomogram establishing the diagnosis of a Stage 4 macular hole, A region of increased reflectivity in the posterior hyaloid directly above the fovea most likely represented an operculum,

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