Optical Coherence Tomography (OCT) Biomarkers for Nonsurgical Management of Postvitrectomy Secondary Macular Holes With Intravitreal Triamcinolone Acetonide (1 mg/0.1 mL): A Case Report of Two Cases.

Abstract

Purpose: To report optical coherence tomography (OCT) biomarkers for nonsurgical management of secondary macular holes.

Case series: We report two cases in which postvitrectomy macular holes were managed with preservative-free intravitreal triamcinolone acetonide (1 mg/0.1 mL). All the patients underwent OCT examination before and after injection. Patients 1 and 2 experienced closure of the macular hole. The OCT biomarkers for the patients were (1) an apical diameter of less than 100 microns, (2) the presence of subretinal fluid, (3) the presence of a perifoveal cuff of fluid, and (4) the absence of preretinal traction.

Discussion: The incidence of secondary macular holes is reported to range from 0.24% to 1.9% of patients who undergo vitrectomy. Secondary macular holes are also reported postvitrectomy due to inadvertent iatrogenic trauma, cystoid macular edema, etc. The treatment of secondary macular holes essentially involves various modifications of the ILM flap technique. There have been reports on the closure of secondary macular holes with the intravitreal injection of triamcinolone acetonide, intravitreal bevacizumab, aflibercept, NSAID, and difluprednate. The identification of OCT biomarkers prior to vitrectomy can help in targeted use of nonsurgical treatment modalities in the management of secondary macular holes with the intravitreal injection of triamcinolone acetonide (1 mg/0.1 mL).

Conclusion: Identification of OCT biomarkers can help in the nonsurgical management of secondary macular holes.