Spontaneous Resolution of Macular Hole with Retinal Detachment in a Highly Myopic Eye

Dear Editor, Macular hole (MH) with retinal detachment (RD) predominantly occurs in highly myopic eyes, and is a major vision-threatening complication in pathologic myopia [1]. Treatment of MH with RD results in lower anatomic success rates and poorer functional outcomes than MH without RD. Spontaneous resolution of MH with RD is extremely rare; spontaneous resolution of MH without RD is reported more frequently, especially in cases of traumatic MH. However, we encountered a case of spontaneous resolution of MH with RD in a patient with high myopia(Fig. 1A, 1B), which is described herein with a review of the relevant literature. A 73-year-old female visited our clinic complaining of a decrease in vision in the left eye. Best-corrected visual acuity was 0.8 in the right eye (OD) and 0.04 in the left eye (OS) as measured by a Snellen chart. Optical coherence tomography (OCT; Spectral OCT/SLO, OTI, Toronto, ON, Canada) of the OS confirmed the presence of MH-related RD (Fig. 1C). The patient refused surgical treatment. The clinical history of the patient included Bechet’s disease (5 years before) and bilateral cataract surgery (4 years before). At the time of the surgery, the axial length of the eyes was 27.14 mm (OD) and 28.63 mm (OS). Two years after cataract surgery, Nd-YAG (neodymium-doped yttrium aluminum garnet) capsulotomy was performed in both eyes for after-cataract treatment (posterior capsular opacity after cataract surgery). The patient visited the clinic for a check-up 2 years after MH with RD was diagnosed. Best-corrected visual acuity was 0.8 (OD) and 0.02 (OS) on the Snellen chart. OCT revealed complete retinal attachment as well as spontaneous closure of the MH in the OS (Fig. 1D, 1E). Several cases of spontaneous closure of MH with RD have been reported. Min [2] and Tam et al. [3] reported two cases of spontaneous reattachment of RD with MH; however, these cases were reported before the advent of OCT, a useful tool for the diagnosis of MH. Li et al. [4] described a case of spontaneous closure of MH associated with RD in an eye with high myopia, in which macular detachment was observed until the last follow-up visit; they suggested that a decrease in vitreoretinal traction force may induce spontaneous closure of MH. Furthermore, spontaneous Korean J Ophthalmol 2017;31(6):572-573 ht tps: / /doi.org /10.3341/k jo.2017.0103