Surgical Management of Full-Thickness Macular Hole In A Patient with Pachychoroid Spectrum Disease with Atypical Fundus Autofluorescence After Surgery

Author(s): Rony Carlos Preti, Lívia da Silva Conci, Leonardo Provetti Cunha, Sérgio Luís Gianotti Pimentel, Leandro Cabral Zacharias, Mario Luiz Ribeiro Monteiro

Purpose: To describe a case of atypical full-thickness macular hole (FTMH) in a patient with pachychoroid spectrum disease. The efficacy of surgical intervention is discussed.

Observations: A 64-year-old woman presented with poor vision and metamorphopsia in her left eye (OS). Swept-Source Optical Coherence Tomography (SS-OCT) revealed a grade II FTMH in association with serous macular detachment and indocyanine green angiography (ICGA) showed choroidal hyperpermeability in OS. The patient underwent pars plana vitrectomy (PPV), inner limiting membrane peel, and 20% SF6 gas fill. Macular hole closure was achieved successfully on early postoperative, with opening of FTMH in the right eye in the first posoperative week when patient in positioning. Unusual hyper-autoflurescent peripapillary spots appeared in OS early after PPV with slowly resolution, but followed by RPE mottling. Complete subretinal fluid reabsorption was observed only at 12 months of follow-up.

Conclusions and Importance: FTMH with large subretinal detachment can still be closed with standard PPV technique without fluid drainage. Atypical evolution of this case could be explained by the overlapping of two distinct eye conditions (vitreoretinal interface disease and central serous chorioretinopathy). Multimodal imaging was a useful tool for diagnostic and long-term follow-up significantly helping to understand the unusual postoperative evolution of the case.