SPONTANEOUS CLOSURE OF A MACULAR HOLE AFTER FOUR FAILED VITRECTOMIES IN THE SETTING OF NF-1.
OBJECTIVE
To present the case of a patient who developed spontaneous closure of an idiopathic macular hole after four failed attempts at surgical closure.


METHODS
This is a retrospective case review of the medical record of a single patient. No statistical analysis was performed. The patient is a 71-year-old white woman with neurofibromatosis Type 1 who presented to the retina clinic of one of the authors.


RESULTS
The patient underwent four vitrectomies with long acting gas by two surgeons over the course of 2 years. After each surgery, the hole either did not close or it closed and then reopened within 1 year. Five months after the last surgery (1 year after the hole last reopened), the patient presented with improved vision and spontaneous closure of the macular hole. The hole has remained closed since then.


CONCLUSIONS
This case demonstrates that spontaneous closure of a macular hole, associated with excellent visual recovery, can occur after multiple surgical failures. We propose that enhanced scar formation due to neurofibromatosis Type 1 was responsible for both the numerous failures following initially successful surgery (centrifugal traction) and for the spontaneous closure (centripetal traction).
Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina.
Kendall W
KW
Wannamaker
Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina.
Robert A
RA
Sharpe
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
Jan A
JA
Kylstra
D005260:Female; D006801:Humans; D009456:Neurofibromatosis 1 / Q000175:diagnosis / Q000601:surgery*; D012075:Remission, Spontaneous; D012160:Retina / Q000473:pathology*; D019572:Retinal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012167:Retinal Perforations / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D017211:Treatment Failure; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects*