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PHOTO ESSAY
Year : 2020  |  Volume : 68  |  Issue : 9  |  Page : 1941-1942

Giant macular hole in a case of multifocal choroiditis


Vitreoretina Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Submission07-May-2020
Date of Acceptance28-Jun-2020
Date of Web Publication20-Aug-2020

Correspondence Address:
Dr. Vinod Kumar
Vitreoretina Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1361_20

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  Abstract 


Keywords: Choroiditis, giant macular hole, macula


How to cite this article:
Vukkadala T, Mondal S, Azad SV, Kumar V. Giant macular hole in a case of multifocal choroiditis. Indian J Ophthalmol 2020;68:1941-2

How to cite this URL:
Vukkadala T, Mondal S, Azad SV, Kumar V. Giant macular hole in a case of multifocal choroiditis. Indian J Ophthalmol [serial online] 2020 [cited 2020 Sep 22];68:1941-2. Available from: http://www.ijo.in/text.asp?2020/68/9/1941/292526



A 60-year-old female presented with diminution of vision OU for 10 years. She had frequent episodes of recurrent blurring of vision in the past. There was no history of trauma. Vision was hand movement OD and 1/60 OS. Slit-lamp examination showed no anterior chamber reaction with grade 1 senile cataract. Fundus revealed OU healed multifocal choroiditis. In addition, extensive chorioretinal atrophy involving the posterior pole in OD and a giant full thickness macular hole [MH] of 1.5 disc-diameters with a central island of retinal tissue was noted in OS [Figure 1]a. Fundus autofluorescence showed hyperautofluorescence corresponding to the MH and hypoautofluorescence corresponding to the healed choroiditis scars [Figure 1]b. Spectral domain Optical Coherence Tomography (SD-OCT) revealed a minimum hole diameter of 2327 microns and an island of retinal tissue in the center [Figure 1]c. The patient denied surgery in view of poor prognosis.
Figure 1: Colour fundus photograph (a) of left eye shows multiple healed choroiditis patches and a large macular hole with spared retinal tissue at centre (red arrow). White arrows depict the direction of the OCT scan. Autofluorescence shows hyperautofluorescence corresponding to the MH and hypoautofluorescence corresponding to the healed choroiditis scars (b). SD-OCT (c) shows large full thickness macular hole with with spared retinal tissue at centre (red arrow)

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  Discussion Top


Large macular holes with minimum hole diameter more than 1500 microns are categorized as giant macular holes.[1] Giant macular holes have been reported in the setting of Alport syndrome and following trauma.[2],[3] Features of Alport syndrome including renal failure, sensorineural deafness, and characteristic retinopathy were not present in our case. Probable mechanisms of MH formation in the setting of inflammation include epiretinal membranes of inflammatory origin, repeated vitritis with irregular contraction of premacular vitreous, centrifugal photoreceptor displacement by tangential vitreous traction, and persistent cystoid macular edema.[4.5] Foci of chorioretinitis further make the retinal layers fragile contributing to the formation of MH.[5]

To conclude, we report the occurrence of a giant macular hole in a patient with multifocal choroiditis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s)/ guardian has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Raimundo M, Fonseca C, Silva R, Figueira J. Bilateral giant macular holes: A rare manifestation of Alport syndrome. Eur J Ophthalmol 2019;29:NP13-6.  Back to cited text no. 1
    
2.
Panchal B, Doshi S, Pathengay A. Unilateral giant macular hole in a case of Alport syndrome. Indian J Ophthalmol 2019;67:1731.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Nelson D, Lee G, Marcus D. Traumatic giant macular hole. Retina 2001;21:677-67.  Back to cited text no. 3
    
4.
Gregory ME, Bhatt U, Benskin S, Banerjee S. Bilateral full thickness macular holes in association with serpiginous choroiditis. Ocul Immunol Inflamm 2009;17:328-9.  Back to cited text no. 4
    
5.
Bonnin N, Cornut PL, Chaise F, Labeille E, Manificat HJ, Feldman A, et al. Spontaneous closure of macular holes secondary to posterior uveitis: Case series and a literature review. J Ophthalmic Inflamm Infect 2013;3:34.  Back to cited text no. 5
    


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