Persistent macular hole and cystoid macular edema treated with pars plana vitrectomy after failure with topical therapy.

Abstract

Purpose: To report a patient with a persistent macular hole and cystoid macular edema (CME) successfully treated with pars plana vitrectomy and internal limiting membrane peeling after failed topical therapy.

Methods: Case report.

Results: A 70-year-old male presented with a history of decreased vision in the right eye for 3-4 months. Best-corrected visual acuity at the initial examination was 20/80 in the right eye and 20/30 in the left. Optical coherence tomography demonstrated vitreomacular traction with a full-thickness macular hole and prominent CME in the right eye. He was started on topical prednisolone acetate and ketorolac. The width of the hole initially decreased but eventually returned to baseline size despite continued topical therapy. Conservative management with topical therapy was continued in accordance with the patient's preferences. He later underwent phacoemulsification 20 months after presentation without significant improvement in visual acuity. Pars plana vitrectomy with internal limiting membrane peeling and C3F8 tamponade was ultimately performed 2 years after initial presentation. Postoperatively, the macular hole was closed and visual acuity improved to 20/40 at 3 months.

Conclusion: Macular holes with significant CME may close with topical therapy alone. In persistent or recalcitrant cases, delayed surgical intervention to close the macular hole can be successful even at 2 years.