J Korean Ophthalmol Soc.  2016 Jan;57(1):155-160. 10.3341/jkos.2016.57.1.155.

A Case of Spontaneous Closure of Macular Hole in Infectious Posterior Uveitis Involving the Fovea

• Kim MW
• Kim DY
• Kim YJ
• Joe SG
• Lee JY
• Kim JG

• KMID: 2213863
• DOI: http://doi.org/10.3341/jkos.2016.57.1.155

Abstract

PURPOSE
To report a case of macular hole secondary to presumptive infectious posterior uveitis involving the fovea that spontaneously resolved after medical treatment.
CASE SUMMARY
A 33-year-old male visited our clinic for decreased visual acuity in his left eye. He was treated with immunosuppressive therapy including steroid after bone marrow transplantation. Best corrected visual acuity (BCVA) was 0.05 in the left eye. Slit lamp examination showed mild anterior vitritis, and fundus examination showed a macular hole with surrounding whitish infiltration at the fovea. Spectral domain optical coherence tomography (SD-OCT) revealed a full thickness macular hole with surrounding hyper-reflective masses with an infiltration-like appearance involving all retinal layers. Serum anti-toxocara IgG was positive (ELISA), and eosinophil count and immunoglobulin E was elevated. Under diagnosis of presumptive ocular toxocariasis, the patient was treated with albendazole. After medical treatment for toxocariasis, the whitish foveal infiltration became smaller and more discrete. SD-OCT revealed spontaneous closure of the macular hole, and BCVA was improved to 0.4 after a 4-month follow-up.
CONCLUSIONS
We report a macular hole complicated by presumptive infectious posterior uveitis that experienced spontaneous closure after medical treatment for underlying infection.

Keyword

Macular hole; Posterior uveitis; Spontaneous closure; Toxocariasis

MeSH Terms

Adult
Albendazole
Bone Marrow Transplantation
Diagnosis
Eosinophils
Follow-Up Studies
Humans
Immunoglobulin E
Immunoglobulin G
Immunoglobulins
Male
Retinal Perforations*
Retinaldehyde
Tomography, Optical Coherence
Toxocariasis
Uveitis, Posterior*
Visual Acuity
Albendazole
Immunoglobulin E
Immunoglobulin G
Immunoglobulins
Retinaldehyde

Figure

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  Figure 1. Initial fundus photograph, SD-OCT image and Fluoresce in angiography of patient’s left eye. (A) Fundus photograph re-vealed a mild diffuse vitritis with overlying whitish foveal infiltration. (B) Fluorescein angiography showed centripetal impregnation of the macular lesion and disc stainning on late phase. (C-F) SD-OCT confirmed a full thickness macular hole with overlying whitish foveal infiltration. SD-OCT = spectral domain-optical coherence tomography.

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  Figure 2. The time of eosinophilia (arrow) was coincident with the time of symptom onset.

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  Figure 3. After medical etiological treatment, fundus photographs of the patient’s left eye. Fundus photograph showed gradually more discrete macular whitish infiltration and decreased in size (A, B, C). Four months after medical treatment, fundus photograph demonstrated foveal infiltration was disappeared (D).

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  Figure 4. After medical etiological treatment, SD-OCT of the patient’s left eye. SD-OCT showed gradual spontaneous closure of the macular hole preserving the macular concave figure (A, B, C). Four months after medical treatment, SD-OCT image demonstrated that the macular hole was closed (D). SD-OCT = spectral domain-optical coherence tomography.

Reference

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