J Retin.  2024 May;9(1):94-98. 10.21561/jor.2024.9.1.94.

Delayed Closure of Macular Hole with an Internal Limiting Membrane Flap After Intravitreal Triamcinolone Acetonide Injection: Case Report

• Kim SH
• Lee JE

• KMID: 2556472
• DOI: http://doi.org/10.21561/jor.2024.9.1.94

Abstract

Purpose
To report a case of delayed closure of internal limiting membrane (ILM) flap-covered macular hole after intravitreal injection of triamcinolone acetonide.
Case summary
A 73-year-old female presented with decreased visual acuity in the right eye, which had best-corrected visual acuity (BCVA) of 0.2. The patient was diagnosed with cataract and macular telangiectasia type 2. Optical coherence tomography (OCT) revealed the ‘ILM drape sign,’ in which only the ILM remained with full-thickness neurosensory retinal defect in the right eye. The patient underwent combined 25 gauge (G) pars plana vitrectomy (PPV) and phacoemulsification, ILM peeling with a superior inverted ILM flap technique, and fluid-air exchange (FAX). After surgery, OCT showed that the ILM flap covered the macular hole (MH), which was persistent, with increased macular edema surrounding the hole. As macular edema was worsened at 3 weeks, pseudophakic cystoid macular edema (CME) was suspected. Triamcinolone acetonide was injected twice at 5 and 11 weeks. Oral ibuprofen 400 mg tid was prescribed for 4 weeks. CME and neurosensory defect decreased gradually, and the macular hole closed at 4 months. There was no recurrence as of 18 months after surgery.
Conclusions
After macular hole surgery using the ILM flap technique, hole closure may be delayed when accompanied by postoperative CME. In such cases, CME management would promote the closure of the macular hole.

Keyword

Cystoid macular edema; Idiopathic juxtafoveal retinal telangiectasia; Macular hole