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A case of significant visual improvement in a highly myopic eye with a large macular hole Ikki Sugimoto 1 , Tomoyuki Ishibashi 1 , Toshihide Ikeda 1 , Kazuyuki Emi 1 1Department of Ophtahlmology, Osaka Rosai Hospital pp.1090-1095
Published Date 2022/8/15
DOI https://doi.org/10.11477/mf.1410214471
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Abstract Purpose:To report the case of a patient with significant visual improvement in a highly myopic eye with a large macular hole(MH)treated by vitrectomy.

Case:A 71-year-old female was referred to our hospital because of bilateral mature cataract. Before cataract surgery, the fundi were not visible. After cataract surgery, her corrected visual acuity in the right eye was 0.4.

Findings:The axial length of the right eye with the intraocular lens was 27.4 mm, and optical coherence tomography(OCT)showed a large MH with a minimum hole diameter of 763 μm. She was instructed to maintain ocular fixation on the internal fixation light of the OCT device and the parafoveal region associated with epiretinal membrane(ERM)was imaged. In the first vitrectomy, the internal limiting membrane was inverted and implanted into the MH to close it, and her corrected visual acuity improved to 1.0 3 months postoperatively. However, the retinal outer layer structure in the fovea was still poorly restored, and postoperative microperimeter showed a foveal sensitivity of 0 dB. The fixation point measured by postoperative microperimeter was approximately 1 degree away from the fovea, which was consistent with that preoperatively imaged with OCT. Furthermore, postoperative OCT confirmed the removal of ERM and improvement in retinal morphology in this region. Two years after this vitrectomy, her visual acuity and fixation point remained unchanged.

Conclusion:In this case report, we consider that approximately 1 degree of eccentric fixation had already been established preoperatively, and the restored retinal morphology resulted in the significant improvement in visual acuity.


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