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Case Reports and Small Case Series
October 2000

Bilateral Giant Macular Hole

Arch Ophthalmol. 2000;118(10):1446-1449. doi:

We describe a 47-year-old woman with an extremely large macular hole in each eye, with vertical diameters of 3580 µm OD and 2910 µm OS. Her best-corrected visual acuity was 20/200 OU. A flattening of the macular hole's edge was observed in the right eye after a pars plana vitrectomy; however, the visual acuity remained unchanged. The cause of the macular holes was uncertain but the presence of high myopia and/or her history of taking chloroquine were suspected.

Report of a Case

A 47-year-old woman visited our clinic with a gradual decrease and dimming of central vision that she had first noticed about 20 years previously. When she was 12 years old, her physician prescribed chloroquine (300 mg/d), which she took for 2 years to treat renal failure of unknown cause. Her best-corrected visual acuity at the initial visit was a −10.5-diopter (D) sphere OD, and 20/200 OU with a −11.0-D sphere OS. Fundus examination revealed a large macular hole (MH) in each eye with a vertical diameter of 3580 µm OD and 2910 µm OS (Figure 1). Scanning-laser ophthalmoscope microperimetry images revealed that both eyes' fixation point was located at the upper edges of the MHs (Figure 2). Optical coherence tomography showed that the edges of the MHs were swollen (Figure 3). The patient rejected undergoing fluorescein angiography. To prevent further visual reduction, a pars plana vitrectomy with 12% perfluoropropane gas tamponade was performed on the right eye. A flattening of the MH edge was observed (Figure 4); however, the postoperative visual acuity remained unchanged.

Figure 1.
Fundus photograph of the right (A) and left (B) eyes on the initial visit showing large macular holes with vertical diameters of 3580 µm OD and 2910 µm OS.

Fundus photograph of the right (A) and left (B) eyes on the initial visit showing large macular holes with vertical diameters of 3580 µm OD and 2910 µm OS.

Figure 2.
Scanning laser ophthalmoscope microperimetry images of right (A) and left (B) eye on the first visit. Fixation points of both eyes are located on the upper edges of the holes.

Scanning laser ophthalmoscope microperimetry images of right (A) and left (B) eye on the first visit. Fixation points of both eyes are located on the upper edges of the holes.

Figure 3.
Vertical sections of optical coherence tomography images through the center of the right (A) and left (B) macular holes showing swollen edges of both sides.

Vertical sections of optical coherence tomography images through the center of the right (A) and left (B) macular holes showing swollen edges of both sides.

Figure 4.
Postoperative fundus photograph of the right eye (A) and vertical sections of optical coherence tomography images through the center of the macular hole in the right eye (B) showing flattening of the edges.

Postoperative fundus photograph of the right eye (A) and vertical sections of optical coherence tomography images through the center of the macular hole in the right eye (B) showing flattening of the edges.

Comment

Banker et al1 reported that the size of idiopathic MHs range from 177 µm to 917 µm (in a study of 164 eyes). Extremely large MHs, as in our relatively young patient, arequite unusual. Although the cause of the MHs in our patient is uncertain, the presence of high myopia or a patient's taking a cumulative dose of greater than 200 g of chloroquine, which is sufficient for causing retinopathy,2,3 may be associated with MH formation. Visual prognosis may not be favorable for vitrectomy for extremely large, chronic MHs.

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Article Information

This work was supported by grant-in-aid 11771051 for Scientific Research from the Japanese Ministry of Education, Science, and Culture, and a Grant for Research on Eye and Ear Science, Immunology, Allergy, and Organ Transplantation from the Ministry of Health and Welfare, Tokyo, Japan.

The authors have no proprietary interest in any product described in this article.

Corresponding author: Shunji Kusaka, MD, Department of Ophthalmology, E-7, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan (e-mail: skusaka@ophthal.med.osaka-u.ac.jp).

References
1.
Banker  ASFreeman  WRAzen  APLai  MY A muticentered clinical study of serum as adjuvant therapy for surgical treatment of macular holes. Arch Ophthalmol. 1999;1171499- 1502Article
2.
Carr  REGouras  PGunkel  RD Chloroquine retinopathy: early detection by retinal threshold test. Arch Ophthalmol. 1966;75171- 178Article
3.
Bernstein  HN Ophthalmologic considerations and testing in patients receiving long-term antimalarial therapy. Am J Med. 1983;7525- 34Article
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