This 73YO male was seen on 2/10/22 with 20/40 vision and an asymptomatic partial lamellar macular hole from an epiretinal membrane. Cataract surgery was performed on 5/25/22, and vision improved to 20/50 postoperatively.
However, on 7/20/22, vision decreased to 20/200 due to a new, extremely tiny full-thickness macular hole and pseudophakic cystoid macular edema (CME). Topical prednisolone acetate 1% and diclofenac QID were prescribed.
The macular hole partially closed one month later with 20/80 vision, and he was tapered off of topical therapy. When last examined on 1/18/23, vision had improved to 20/70.
OCT shows a stable appearance with a persistent outer retinal defect. We recommended continued observation.
Learning Points:
Topical steroid and non-steroidal therapy can sometimes close macular holes without traction, especially those that are small and associated with significant CME (see Ophthalmology Retina 2020;4:695-699). We therefore usually recommend topical therapy for selected symptomatic patients before proceeding to surgery.
