This 51YO presented with counting-fingers vision secondary to a large (600-micron), full-thickness macular hole.
Swept-source OCT shows the classic appearance of a hole from a foveal dehiscence, with cystic thickening. A small remnant of the outer retina is adherent to the underlying RPE.
Vitrectomy surgery was recommended.
Learning Points:
En face imaging shows a unique and beautiful perspective of the hole. As described by Govetto et al (AJO 2020;212:43-56), idiopathic macular holes have a sunflower appearance showing features of both exudative and tractional cystoid spaces.
The macular hole is hyporeflective centrally with multiple hyporeflective cystoid spaces radiating from the center.
