This 39YO female has been followed by us for over 20 years with high myopia and lattice degeneration. At the last examination 6 months earlier, vision was 20/70 OD. She returned 6 months later with asymptomatic decreased vision in her right eye. Vision was counting fingers.
Optos color RG imaging shows a rhegmatogenous retinal detachment (RRD) extending from the macula into the midperiphery. Triton swept-source OCT confirms the causative macular hole. A partial PVD temporally extends and elevates the nasal edge of the hole, with complex elevated epiretinal membranes extending towards the nerve. The detached neurosensory retina is diffusely thickened with mostly outer nuclear layer cysts. The hole and detachment are best visualized with the green channel.
Three months following vitrectomy and subsequent cataract surgery, vision improved to 20/200. Although the retina was completely attached, the macular hole remained open clinically and on OCT. Our patient was functioning well and deferred further surgery.
Learning Points:
RRD with concurrent non-causal macular holes are uncommon, occurring in 2% of eyes (Iros et al, Retina 2023;43:581-584). Repair of the causative peripheral break(s) without addressing the MH nearly always repairs the detachment and the MH, although many will also perform internal limiting membrane peeling. We have seen several high myopes, including our current patient, with macular holes causing posterior RRD. Vitrectomy in these eyes also has a high surgical success rate, although persistent subretinal fluid may be more common (Cheng et al, Retina 2024;44:782-790).
