Spontaneous Closure of a Fully Developed Macular Hole in a Severely Myopic Eye

Purpose. Myopic macular holes can be difficult to close with surgery and are frequently associated with retinal detachment. We report on a case of a macular hole in a severely myopic eye that underwent spontaneous closure. Methods. An observational case study. Results. A 55-year-old female was referred to Ophthalmology for a central scotoma and metamorphopsia in the right eye. Visual acuity was 1/20 in both eyes. Fundus examination showed loss of the foveal depression, with a small yellow ring in the center of the fovea in the right eye, and a tilted optic disc and peripapillary staphyloma bilaterally. Spectral domain optical coherence tomography (SD-OCT) revealed a fully developed macular hole with a rim of thickened and slightly elevated retina in the right eye. The patient refused surgery. After 4 years of follow-up, her visual acuity improved to 20/40 in the right eye, and SD-OCT revealed spontaneous sealing of the macular hole without bare retinal pigment epithelium. Conclusions. Myopic macular holes represent a challenge regarding their management, and the prognosis is often poor. 1. Introduction Macular holes are rare in the general population, although they are found as a common complication in severely myopic eyes, and can be associated with retinal detachment [1]. Foveal detachment often precedes the formation of a macular hole in severely myopic eyes [2]. A small percentage (6.3%) of severely myopic eyes develop a macular hole in the absence of visual symptoms [1]. Enlargement of the lesion, or posterior retinal detachment, can cause insurgence of symptoms such as metamorphopsia or reduced central visual acuity. The pathogenesis of macular holes in eyes that are severely myopic has been widely examined, although it is still not fully understood. Several factors have been proposed to be causative, including axial length elongation of the myopic eye, posterior staphyloma, chorioretinal atrophy, and vitreous modifications, such as posterior vitreous detachment and posterior vitreous schisis that induces anteroposterior or tangential vitreous traction [3]. Controversy also remains regarding the management and prognosis of such lesions. Macular holes vary from those that are idiopathic to those that are severely myopic. The myopic form appears to be more difficult to close with surgery and to be associated with a higher incidence of retinal detachment. Spontaneous closure of full-thickness idiopathic macular holes has been described in 3.5% of patients, at around 60 days after initial presentation and before scheduled surgery [4]. To the best of