Full-thickness macular hole with pigment epithelial detachment.

A 60-year-old female presented with diminution of vision in the right eye which was noticed 1 month ago with visual acuity of 20/80, fundus examination revealing full-thickness macular hole (FTMH) with pigment epithelial detachment (PED). Fundus fluorescein angiography [Fig. 1a and b] revealed early phase stippled appearance with hyperfluorescence in late phase suggestive of neovascular age-related macular degeneration (n-AMD). Optical coherence tomography (OCT) [Fig. 1c] revealed FTMH with PED. The left eye examination was normal. The patient received three doses of intravitreal ranibizumab with < 50μ reduction in the size of PED on OCT [Fig. 1d].

Figure 1

(a) Early fundus fluorescein angiography (FFA) image showing stippled appearance. (b) Late FFA image showing diffuse leak. (c) Full-thickness macular hole (FTMH) with pigment epithelial detachment (PED) before intravitreal anti-vascular endothelial growth factor (VEGF) (at baseline). (d) FTMH with PED after three doses of intravitreal anti-VEGF (after treatment)

FTMH with PED is a very rare entity. Few cases are reported in the literature with contrasting outcomes with anti-vascular endothelial growth factor/vitrectomy.[12] Pathologic mechanisms are uncertain. Response to treatment predicts the final visual outcome.

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