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Case 3-2. Stage 2 Macular Hole and Surgical Treatment

Clinical Summary

A 72-year-old man was referred for evaluation of a macular hole in his right eye. On examination, his visual acuity in this eye was 20/70, and a small Stage 2 hole was identified in the macula (A).

A horizontal OCT scan (B) showed a narrows full-thickness retinal dehiscence with a thin, attached operculum consistent with a Stage 2 classification. There were significant cystic changes surrounding the hole which were manifest by retinal swelling and decreased intraretinal optical reflectivity

Case 3-2 continued

Follow-up Examination

Pars plana vitrectomy surgery was performed with autologous serum and injection of 15% C.F. Three weeks after surgery, the patient's visual acuity was 20/200. Dilated fundus examination revealed a partial gas fill and closure of the hole (C).

Follow-up Optical Coherence Tomography

OCT (D) showed reapproximation of the edges of the hole and a reduction in the amount of surrounding retinal edema. A residual subretinal space was identified below the fused edges.

Case 3-3* Stage 2 Macular Hole and Macular Hole Development

CMnical Summary

A 59-year-old woman was referred for declining vision in her right eye. Her visual acuity was 20/200 in this eye and dilated fundus examination (A) revealed a Stage 3 or Stage 4 macular hole with a cuff of retinal thickening, In the fellow eye (B), a subtle increase in foveal redness and a reduced foveal reflex was observed. The visual acuity was 20/20. j

Optical Coherence Tomography

A horizontal OCT section (C; white line on A) through the hole in the right eye showed a full-thickness loss of retinal tissue with two non-reflective spaces within the neurosensory retina corresponding to cysts. The posterior hyaloid appeared as a faint, minimally reflective membrane approximately 400 um anterior to the retina. The reflection from the posterior vitreous was patchy in the foveal region, but the membrane seemed to arise from the proximity of the hole and increase in separation from the retina distally A sequence of vertical OCT tomograms (D; black lines on A) demonstrated a partial break in the outer retinal layers and an operculum attached to the edge of the hole, suggesting a Stage 2 classification. The minimally reflective band corresponding to the posterior hyaloid appeared to be attached to the operculum in scans C and E of the collage.

A vertical OCT tomogram (E) acquired through the fellow eye exhibited a normal appearing fovea with a peri foveal detachment of the posterior vitreous.

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Log Reflection

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