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Ophthalmic Images

Full-thickness macular hole with pigment epithelial detachment

Narnaware, Shilpi H; Bawankule, Prashant K1

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Indian Journal of Ophthalmology: June 2020 - Volume 68 - Issue 6 - p 1185
doi: 10.4103/ijo.IJO_1591_19
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A 60-year-old female presented with diminution of vision in the right eye which was noticed 1 month ago with visual acuity of 20/80, fundus examination revealing full-thickness macular hole (FTMH) with pigment epithelial detachment (PED). Fundus fluorescein angiography [Fig. 1a and b] revealed early phase stippled appearance with hyperfluorescence in late phase suggestive of neovascular age-related macular degeneration (n-AMD). Optical coherence tomography (OCT) [Fig. 1c] revealed FTMH with PED. The left eye examination was normal. The patient received three doses of intravitreal ranibizumab with < 50μ reduction in the size of PED on OCT [Fig. 1d].

Figure 1
Figure 1:
(a) Early fundus fluorescein angiography (FFA) image showing stippled appearance. (b) Late FFA image showing diffuse leak. (c) Full-thickness macular hole (FTMH) with pigment epithelial detachment (PED) before intravitreal anti-vascular endothelial growth factor (VEGF) (at baseline). (d) FTMH with PED after three doses of intravitreal anti-VEGF (after treatment)

FTMH with PED is a very rare entity. Few cases are reported in the literature with contrasting outcomes with anti-vascular endothelial growth factor/vitrectomy.[12] Pathologic mechanisms are uncertain. Response to treatment predicts the final visual outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

1. Inoue M, Tan A, Slakter JS, Chang S, Kadonosono K, Yannuzzi LA. Full-thickness macular hole combined with pigment epithelial detachment using multimodal imaging Retin Cases Brief Rep. 2017;11:369–72
2. Cazabon S. Full-thickness macular hole formation associated with pigment epithelial detachment: Link or coincidence.? Int Ophthalmol. 2010;30:739–42
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