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PHOTO ESSAY
Year : 2018  |  Volume : 66  |  Issue : 6  |  Page : 848-849

Acute full-thickness macular hole after uneventful femtosecond-assisted cataract surgery and its spontaneous closure


Iladevi Cataract and IOL Research Centre, Ahmedabad, Gujarat, India

Date of Submission27-Nov-2017
Date of Acceptance03-Mar-2018
Date of Web Publication22-May-2018

Correspondence Address:
Dr. Deepak Bhojwani
Raghudeep Eye Hospital, Gurukul Road, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1177_17

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  Abstract 


Keywords: Complications of cataract surgery, femtosecond assisted cataract surgery,macular hole, sponatneous closure


How to cite this article:
Bhojwani D, Vasavada S, Sudhalkar A, Vasavada V, Vasavada AR. Acute full-thickness macular hole after uneventful femtosecond-assisted cataract surgery and its spontaneous closure. Indian J Ophthalmol 2018;66:848-9

How to cite this URL:
Bhojwani D, Vasavada S, Sudhalkar A, Vasavada V, Vasavada AR. Acute full-thickness macular hole after uneventful femtosecond-assisted cataract surgery and its spontaneous closure. Indian J Ophthalmol [serial online] 2018 [cited 2020 Dec 3];66:848-9. Available from: https://www.ijo.in/text.asp?2018/66/6/848/232830



Full-thickness macular hole (FTMH) is a very rare complication of modern day cataract surgery.[1] Although the exact etiology is unknown, anteroposterior vitreous forces are thought to induce acute posterior vitreous detachment (PVD) or traction around the fovea resulting in macular hole formation.[2]

We present this photo essay to highlight the importance of incorporating ocular coherence tomography (OCT) and comprehensive ocular examination as a part of preoperative workup for cataract surgery.


  Case Presentation Top


A 67-year-old female with visually significant cataract (visual acuity 20/80) in her left eye came for cataract consult. Rest of examination including her fellow eye was unremarkable [Figure 1]. After counseling, she underwent uneventful femtosecond-assisted cataract surgery (ALCON LENSx platform) with implantation of multifocal intraocular lens (MF-IOL).
Figure 1: Preoperative color fundus photographs and horizontal raster ocular coherence tomography images of right eye (a and b) and left eye (c and d). Please note haziness of left fundus photograph secondary to cataract

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At 2 weeks' follow-up, her left eye visual acuity was still 20/80, and she complained of metamorphopsia. Anterior segment examination revealed well-centered MF-IOL. Fundus examination revealed an FTMH confirmed on OCT [Figure 2]a and [Figure 2]b. Interestingly, we also noted focal foveal vitreomacular adhesions (VMA) which were not seen preoperatively. Since the macular hole was small (<400 μ) and we were clueless for the cause of it, we preferred to observe it with close follow-ups.
Figure 2: Composite postoperative images of the left eye at 15 days (a) Fundus photograph showing small macular hole (arrow-line). (b) horizontal raster ocular coherence tomography image confirming small full thickness macular hole with central focal vitreomacular adhesions (block arrow). (c and d) 1 month follow-up fundus photograph and horizontal raster ocular coherence tomography image documenting spontaneous resolution of vitreomacular adhesions (block arrow) and closure of macular hole. (e and f) 3 months' follow-up fundus photographs and horizontal raster ocular coherence tomography image showing complete closure of macular hole

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One-month postoperatively, she reported improvement in the left eye visual acuity to 20/40. OCT revealed partial closure of macular hole with a resolution of VMA [Figure 2]c and [Figure 2]d. At 3 months, visual acuity was restored to 20/20 with complete closure of macular hole and subjective improvement of metamorphopsia [Figure 2]e and [Figure 2]f. She maintained a visual acuity of 20/20 without metamorphopsia at 6 months and 1 year visits.


  Discussion Top


Comprehensive ocular examination coupled with detailed assessment of optic disc and macula is inarguably an essential key to diagnose and treat the majority of intraocular disorders. OCT has been accepted as the most accurate and reliable diagnostic tool for assessment of optic disc and macular disorders.[3],[4] And so today OCT has become an indispensable diagnostic armamentarium of every ophthalmologist.


  Conclusion Top


We believe acute PVD with subclinical anomalous VMA trigerred by cataract surgery responsible for FTMH in our case. This case illustrates the role of OCT in diagnosing and managing vitreoretinal interface anomalies. Furthermore, it highlights the possibility of spontaneous closure of full-thickness macular hole after cataract surgery with good visual outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) 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.
Li W, Zhao Y, Zheng Q, Wu R, Zheng J, Zheng B, et al. Phacoemulsification complication. Ophthalmology 2010;117:1275.e1-3.  Back to cited text no. 1
    
2.
Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, et al. The international vitreomacular traction study group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology 2013;120:2611-9.  Back to cited text no. 2
[PUBMED]    
3.
Fallon M, Valero O, Pazos M, Antón A. Diagnostic accuracy of imaging devices in glaucoma: A meta-analysis. Surv Ophthalmol 2017;62:446-61.  Back to cited text no. 3
    
4.
Steel DH, Lotery AJ. Idiopathic vitreomacular traction and macular hole: A comprehensive review of pathophysiology, diagnosis, and treatment. Eye (Lond) 2013;27 Suppl 1:S1-21.  Back to cited text no. 4
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

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