SPONTANEOUS CLOSURE OF A LARGE STAGE III MACULAR HOLE AFTER PANRETINAL PHOTOCOAGULATION IN A PATIENT WITH SEVERE PROLIFERATIVE DIABETIC RETINOPATHY

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Abstract

Purpose:

To report spontaneous closure of a tractional Stage III macular hole (MH) in a patient with proliferative diabetic retinopathy (PDR) after panretinal photocoagulation (PRP).

Methods:

Case report of a 43-year-old man with poorly controlled Type I diabetes and bilateral severe proliferative diabetic retinopathy.

Results:

On presentation, visual acuity was 20/400 and fundus examination was significant for a Stage III tractional MH in the left eye. Vision in the right eye was light perception from neovascular glaucoma. Fluorescein angiography showed extremely severe macular and peripheral ischemia, disk neovascularization, and macular traction from fibroglial tissue. After 5 panretinal photocoagulation sessions over 3 months, the MH spontaneously closed; however, vision remained 20/400. Fluorescein angiography showed regressed disk neovascularization and mild diffuse macular leakage. After a 13-month loss to follow-up, he presented with 20/300 vision, and, despite extensive macular traction from fibroglial tissue, the MH remained closed. Owing to progressive traction from the fibroglial tissue, macular retinal detachment occurred and vision decreased to hand motions. The patient underwent pars plana vitrectomy, scar tissue removal, silicone oil tamponade, and laser. Postoperatively, visual acuity decreased to no light perception because of neovascular glaucoma complications and lack of proper follow-up.

Conclusion:

Spontaneous closure of a Stage III MH may occur in patients with PDR after PRP; however, it may not result in long-term visual improvement.

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