The authors present a case of closure of a full thickness macular hole in a patient with Behçet’s disease, without surgery. The 23-year-old male they describe presented with a history of recurrent oral aphthous ulcers and a genital ulcer. Ocular examination revealed inflammation of the anterior chamber and vitreous of the right eye, and periphlebitis and cystoid macular oedema in the left eye. He was prescribed hourly topical corticosteroids, cycloplegics and oral azathioprine. Follow-up examinations revealed the development of a retinal infiltrate in the right eye which promoted the addition of oral cyclosporine A and oral corticosteroids. Three months after initial presentation he developed an attack of panuveitis in the left eye, which was adequately controlled by increasing the dose of oral corticosteroids. Subsequent follow-up revealed a full thickness macular hole in the left eye. The patient was put on the waiting list for surgical closure of the macular hole. In the meantime he developed another attack of panuveitis in his left eye. Subcutaneous interferon alpha-2b treatment was started and tapered accordingly. Two months after treatment the macular hole had fully closed with an increase in the patient’s visual acuity. The authors highlight the role of cystoid macular oedema and abnormal vitreoretinal tractions secondary to inflammation in contributing to macular hole formation. In this particular case the authors suggest that the second attack of inflammation may have caused glial or retinal pigment epithelium (RPE) cell proliferation to bring the hole edges closer together. Subsequent control of the inflammation caused resolution of the cystoid macular oedema and release of vitreous traction. They conclude by saying surgery may be avoided by strict control of inflammation in Behçet’s disease macular holes
Inflammatory macular holes
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