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Introduction
Idiopathic macular hole is a relatively frequent retinal disease characterized by a full-thickness anatomic defect in the fovea, leading to visual function decrease, metamorphopsia, and central scotoma. Idiopathic macular holes usually occur in elderly patients and are more frequent in women.
Although the natural history of idiopathic macular hole usually leads to progression through four clinical stages from an impending lesion to a full-thickness defect involving all retinal layers, spontaneous macular hole closure has been reported as an infrequent event. 1 The exact mechanism of spontaneous macular hole closure is still unclear, but four different hypotheses have been proposed: complete vitreous detachment over the fovea releasing the anteroposterior tractional forces, formation of an epiretinal membrane resulting in hole shrinkage and closure, glial cell proliferation at the base of the hole, and growth of retinal tissue bridging over the hole. 2
Since optical coherence tomography (OCT) was introduced into clinical practice, important insights into idiopathic macular hole development and progression have been provided. OCT currently represents an essential tool in defining idiopathic macular hole stage and size and in evaluating abnormalities in the vitreofoveal interface. Spectral-domain OCT (SD-OCT) is the newest generation OCT system that offers improved visualization of retinal architecture and morphology compared with time-domain OCT and is particularly sensitive for visualizing the inner and outer segments of the photoreceptors and the internal and external limiting membranes.
We present SD-OCT findings in three patients with stage II, III, and IV idiopathic macular hole showing spontaneous closure due to different hypothetical mechanisms.
Case Reports
Case 1
A 64-year-old woman presented with a complaint of bilateral progressive vision decrease over the previous 6 months. The best-corrected initial visual acuity (BCVA) was 20/100 in her right eye and 20/70 in her left eye. Binocular stereoscopic slit-lamp ophthalmoscopy with Super Field lens (Volk Optical Inc., Mentor, OH) revealed a full-thickness macular hole in both eyes. SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec, Inc., Dublin, CA) showed a full-thickness stage IV macular hole in her right eye and a full-thickness stage II macular hole in her left eye (Fig. 1A). The basal and minimal diameters were 400 and 237 μm in the right eye and 392 and 338 μm in the left eye.
Vitrectomy with internal limiting membrane peeling...