Spontaneous macular hole closure with appearance of epiretinal membrane: implications for therapy.

A 69-year-old man had spontaneous closure of a macular hole 2 years after his initial presentation that was documented by optical coherence tomography. This was related to an increase in an associated epiretinal membrane. Preretinal tissue proliferation is a necessary prerequisite for macular hole closure, whether spontaneous or induced surgically. A guiding template, such as the overlying posterior hyaloid surface or a gas bubble interface, facilitates closure. In this case, the posterior hyaloid was visibly separated and the macular hole was well developed. It is possible that the contraction of the epiretinal membrane narrowed the gap enough to allow closure. This mechanism may have important implications for developing surgical management techniques.