An early "reopening" case of idiopathic macular hole; supportive usefulness of fundus autofluorescence

Background: Anatomical closure of macular holes (MH) is now largely confirmed by optical coherence tomography (OCT). Fundus autofluorescence (FAF) is also helpful in diagnosis and anatomical estimation of MH. We report a case of early reopening of anatomically closed MH, 2 days after release from face-down positioning where FAF abnormalities proceeded OCT findings. Methods: A case report. A 67-year-old woman underwent vitrectomy with brilliant blue G-assisted ILM peeling for the treatment of full-thickness stage 4 MH (diameter 578 μm). FAF and OCT were used to evaluate the patient. Results: On post operative day 3, OCT showed anatomical closure of MH, but FAF persistently demonstrated hyperfluorescence in the fovea. On post operative day 5, 2 days after termination of positioning, OCT showed reopening of the MH. Intra-vitreous injection of 50 % sulfur hexafluoride (SF₆) gas was performed followed by face-down positioning again. Fourteen days after surgery, we confirmed the findings of both the anatomical closure in OCT and hypofluorescence on FAF. Two months later, MH remained closed. Conclusions: FAF might be a useful measure as a supportive method to guide release from posture restriction.