Example 1: Full Thickness Macular Hole

History/Chief Complaint

  • A 69 year old Hispanic female presented for follow -up for reduced vision in her left eye for two years secondary to a full thickness macula hole. Macula hole surgery performed elsewhere was unsuccessful. About six months later, she developed a superior temporal branch vein occlusion and then an inferior temporal branch vein occlusion in the same eye. Ocular hypertenslon/early glaucoma was diagnosed and treated with eye drops. She had systemic hypertension which was under medical control and no history of diabetes was reported.

Clinical Findings

  • BCVA: OD 20/25 OS 20/400
  •  Fundus Exam:
    • OD: Within normal limits
    • OS: Obvious macula hole and scattered hemorrhages and exudates temporally

Spectralis® OCT

  • OD: Vitreomacular traction with associated central foveal cavitation (Formation of cystoid cavity located in the inner part of the central fovea secondary to mechanical forces.1)
  • The Photoreceptor Integrity Line (PIL) is intact under the fovea and throughout the scan length (see page 21).
  • OS: Full thickness macula hole with no evidence of VMT. The PIL is not present at the base of the macula hole. Exudates In the temporal retina secondary to previous vein occlusions as well as drusen.

Diagnosis

  • According to a new classification proposed by Jerry Sebag, each eye is manifesting anomalous PVD; one eye with a macular hole and the second eye with vitreal foveal traction syndrome.2

Diagnosis

  • Careful follow-up for glaucoma OU, an early cataract OS and a possible impending macula hole OD.
    Note: Heidelberg Spectralis software with TruTrack™ imaging can be used to monitor for progression