Macular hole formation after toxoplasmic retinochoroiditis: coincidence or rare complication?

Abstract

To the EditorArana et al. [1] recently published an interestingcase report associating macular hole (MH) formationwith toxoplasmic retinochoroiditis (TR). The authorshypothesized that the pathogenesis of MH in a35-year-old patient with TR was inflammation of thevitreous inducing vitreofoveal traction, MH anddetachment.Although we agree with the authors that vitreoret-inal traction due to inflammatory contraction of theposterior hyaloid face might have contributed, at leastto some extent, to the formation of the MH, we wouldlike to highlight another causative factor which meritsconsideration.We recently reported a similar case of full-thick-ness MH formation after TR and investigated theretinochoroidal blood flow in the area of the TRlesions [2]. Interestingly, the affected eye showedsignificant retinochoroidal hypoperfusion in the areaof inflammation compared to the corresponding ana-tomical location in the fellow eye [2]. Moreover,fundus examination in our patient did not reveal anyprominent vitreoretinal traction. Research has shownthat retinal ischaemia can result in MH formation [3].Our clinical observation supports the hypothesis thatMH formation in cases of TR may result from retinalhypoperfusion and/or vitreoretinal traction.We believe that evaluation of retinochoroidalperfusion in cases of TR is important in order toinvestigate the pathophysiology of MH formation.References