Abstract
Purpose. Pathophysiology of macular hole (MH) is not yet well defined but the advances of spectral domain optical coherence tomography (SD-OCT) give us access to further detailed imaging. We report a case with macular inner segment ellipsoid (ISe) band loss and cone outer segment tips (COST) line changes seen in SD-OCT preceding MH appearance in a young patient. Methods. 21-year-old woman presented with a partial central scotoma, metamorphopsia, and a 20/25 vision in her right eye. Past medical history was positive for laser assisted in situ keratomileusis (LASIK) surgery 7 months ago with no complications. Macular SD-OCT showed ISe band loss and COST line elevation. She was followed a month later with visual acuity deteriorating to 20/200 and a full thickness MH. Results. The patient underwent a pars plana vitrectomy with internal limiting membrane peeling. Her visual acuity 2 months later was 20/20. Conclusion. SD-OCT can identify preliminary changes, yet to be described, preceding MH formation. Our patient demonstrated ISe band loss and COST abnormalities on SD-OCT a month prior to MH development. SD-OCT should be considered in young patients with subtle visual symptoms and mild changes in visual acuity that are not readily explained by ophthalmological exam.
Highlights
Macular hole (MH) is an idiopathic condition that in most cases is related to posterior vitreous detachment (PVD) and is mainly seen in the elderly
Gass studied the pathophysiology of MH and suggested that the majority of macular holes begin as a central dehiscence with little loss of retinal tissue following tangential traction [8]
We showed an interruption of the retinal tissue at the level of the inner segment ellipsoid (ISe) and cone outer segment tips (COST) line on spectral domain optical coherence tomography (SD-OCT) a month before full thickness macular hole (FTMH) appearance, but our case did not show any abnormality in ophthalmoscopy
Summary
Macular hole (MH) is an idiopathic condition that in most cases is related to posterior vitreous detachment (PVD) and is mainly seen in the elderly. Spectral domain optical coherence tomography (SDOCT) provides further detailed imaging that allows the detection of early anatomical changes, enabling us to alter and/or refine current theories. Different pathophysiological mechanisms might be involved in MH formation depending on vitreous syneresis and posterior hyaloid status. Several theories have emerged involving tangential traction [3] and anterior-posterior traction [4, 5]. Several anatomical changes have been described as the primary findings in the macular hole development such as intraretinal split, foveal pseudocyst, and foveolar detachment [5,6,7]
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