Two cases of diabetic macular edema complicated by an atypical macular hole

Yuich Yoshida,Tsunehiko Ikeda,Teruyo Kida,Takaki Sato,Takatoshi Kobayashi,Masashi Mimura,Masanori Fukumoto,Shou Oosuka

doi:10.1186/s12886-020-01444-7

Yuich Yoshida, Tsunehiko Ikeda + Show 6 more

Open Access

https://doi.org/10.1186/s12886-020-01444-7

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Journal: BMC ophthalmology	Publication Date: Apr 29, 2020
Citations: 4	License type: open-access

Affiliation: Osaka Medical and Pharmaceutical University

Abstract

BackgroundHere we report two patients who developed an atypical macular hole (MH) during the treatment course for diabetic macular edema (DME).Case presentationsPatient 1 was a 73-year-old male. Optical coherence tomography (OCT) revealed perifoveal retinoschisis (RS) in addition to cystoid macular edema and serous retinal detachment (SRD) in his left eye, and that an MH had developed during the clinical course. A convex surface was formed at the MH margin toward the vitreous cavity, and granular shadows were observed in the fluid cuff. Intraoperative findings revealed a thin epiretinal macular membrane (ERM) around the MH. Patient 2 was a 79-year-old male. Although the patient underwent pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) in both eyes, RS and a thin ERM in addition to SRD was observed in his left eye after surgery, and an MH developed during the clinical course. As in Patient 1, a convex surface was formed at the fluid cuff margin toward the vitreous cavity.ConclusionsBoth patients had persistent DME, SRD, RS, and a thin ERM before the development of the MH. OCT revealed the formation of a convex surface at the MH margin toward the vitreous cavity, suggesting that the fragility of the layered structure of the retina combined with tangential retinal traction may have been involved in the atypical MH form.

Highlights

We report two patients who developed an atypical macular hole (MH) during the treatment course for diabetic macular edema (DME).Case presentations: Patient 1 was a 73-year-old male
Optical coherence tomography (OCT) revealed the formation of a convex surface at the MH margin toward the vitreous cavity, suggesting that the fragility of the layered structure of the retina combined with tangential retinal traction may have been involved in the atypical MH form
We report 2 cases of MHs that developed following anti-VEGF therapy and pars plana vitrectomy (PPV) for DME in which the MH showed the formation of a convex surface toward the vitreous cavity, unlike a typical idiopathic MH, and discuss the cause of the MH in each case

Summary

Introduction

We report two patients who developed an atypical macular hole (MH) during the treatment course for diabetic macular edema (DME).Case presentations: Patient 1 was a 73-year-old male. Conclusions: Both patients had persistent DME, SRD, RS, and a thin ERM before the development of the MH. OCT revealed the formation of a convex surface at the MH margin toward the vitreous cavity, suggesting that the fragility of the layered structure of the retina combined with tangential retinal traction may have been involved in the atypical MH form.

Results

Conclusion