Spontaneous Resolution of an Idiopathic Macular Hole Documented by Spectral-Domain Optical Coherence Tomography: A Case Report.

Introduction/Background: Spontaneous closure of idiopathic macular holes (MH) has been documented with imaging techniques, but the pathogenesis of the formation and the closure remains unclear although there are some hypotheses. The aim of our case report, monitored with OCT imaging, is to add further support to one of these hypotheses: the closure by a retinal tissue bridge over the MH, and to stress the importance of a short period of observation. Methods: Observational case report. OCT imaging was used to monitor the formation and resolution of a case of an idiopathic stage III macular hole. Results: A 77 year-old woman with an ocular history of a retinal detachment in the right eye 20 years ago with a poor outcome and a mild diabetic retinopathy, came to the emergency room with blurred vision of 3 days of evolution in the left eye. During exploration, the best-corrected visual acuity (BCVA) was 0.5 LOGMAR in the left eye. On OCT, a lamellar hole and a subclinical posterior vitreous detachment were diagnosed and follow-up visits were programmed. Six months later, BCVA was 0.2 and a full-thickness MH was diagnosed; surgery was proposed, but the patient denied. Ten months after the initial examination, the BCVA was 0.6 and the full-thickness MH was covered by a retinal bridge. Five months later, there was a complete resolution of the MH with normal foveal contour that stabilised in the following months and remains unchanged until now. Conclusions: Observation of MH during the first months is advised, especially when the diameter is small. We also want to draw attention to the potential mechanism through which a MH with no vitreomacular traction can resolve. It has been proposed the implication of Müller cells in forming a bridge of retinal tissue, but further investigations need to be done in this direction. Acknowledgements: To Elena Sorlí Clemente, Francisco Ramos Martí, and especially Ana Montoliu Antón and Soledad Peña. [ABSTRACT FROM AUTHOR]