An early "reopening" case of idiopathic macular hole; supportive usefulness of fundus autofluorescence.
BACKGROUND
Anatomical closure of macular holes (MH) is now largely confirmed by optical coherence tomography (OCT). Fundus autofluorescence (FAF) is also helpful in diagnosis and anatomical estimation of MH. We report a case of early reopening of anatomically closed MH, 2 days after release from face-down positioning where FAF abnormalities proceeded OCT findings.


METHODS
A case report. A 67-year-old woman underwent vitrectomy with brilliant blue G-assisted ILM peeling for the treatment of full-thickness stage 4 MH (diameter 578 microm). FAF and OCT were used to evaluate the patient.


RESULTS
On post operative day 3, OCT showed anatomical closure of MH, but FAF persistently demonstrated hyperfluorescence in the fovea. On post operative day 5, 2 days after termination of positioning, OCT showed reopening of the MH. Intra-vitreous injection of 50 % sulfur hexafluoride (SF(6)) gas was performed followed by face-down positioning again. Fourteen days after surgery, we confirmed the findings of both the anatomical closure in OCT and hypofluorescence on FAF. Two months later, MH remained closed.


CONCLUSIONS
FAF might be a useful measure as a supportive method to guide release from posture restriction.
Arima
Mitsuru
M
Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Miyazaki
Masanori
M
Kohno
Ri-ichiro
R
Hata
Yasuaki
Y
Ishibashi
Tatsuro
T
D000368:Aged; D001485:Basement Membrane / Q000601:surgery; D004396:Coloring Agents; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D019793:Fluorescein; D005654:Fundus Oculi; D006801:Humans; D016684:Prone Position; D012008:Recurrence; D012167:Retinal Perforations / Q000175:diagnosis* / Q000628:therapy; D012394:Rosaniline Dyes; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D041623:Tomography, Optical Coherence; D014821:Vitrectomy
D004396:Coloring Agents; D012394:Rosaniline Dyes; C004692:coomassie Brilliant Blue; D019793:Fluorescein; D013459:Sulfur Hexafluoride