1. Optical Coherence tomography Imaging of Spontaneous closure of Psuedophakic full thickness macular hole, 8 months post operative Dr. Jenin Patel Lotus Eye Hospital Mumbai India NO FINANCIAL INTEREST

2. PURPOSE To report a case of spontaneous closure of full thickness macular hole (FTMH), associated with cystoid macular edema (CME), eight months post cataract surgery. Traumatic macular holes are known to close spontaneously. Closure of Post operative FTMH associated with CME is not reported to the best of our knowledge.

3. CASE Sixty year old patient presented with a drop in visual acuity from LogMAR O.20 to LogMAR 0.70,4 months post cataract surgery. He was diagnosed to have a (FTMH) with CME and posterior vitreous detachment. He was diagnosed to have a (FTMH) with CME and posterior vitreous detachment. The patient was started on low dose topical steroids and NSAID as the medical management.

4. OCT confirmed the findings of FTMH measuring 819 microns at the base and cystoid changes measuring 508 microns

5. The patient followed up after four months. Repeat OCT showed the bridging of the macular hole, then complete closure,with improvement of visual acuity to o.4 log MAR. Macular thickness now measured 268 microns.

6. Closure mimicking a foveal detachment Inward protrusion of tissue around the hole

7. MECHANISM OF CLOSURE Spontaneous macular hole closure began as an inward protrusion of the tissue around the hole. Which then connected to bridge the hole mimicking a foveal detachment. This, then thickens with resolving perifoveal cysts to regain its normal configuration.

8. COMPLETE CLOSURE WITH RESOLVED CME VISUAL RECOVERY TO 0.4 log MAR.AT THIS STAGE

9. OTHER PROPOSED MECHANISM Complete detachment of the posterior hyloid over the fovea. Cellular proliferation at the base of the hole. Formation of the epi retinal membrane. Formation of retinal bridge over hole.

10. DISCUSSION Pseudophakic CME are known to cause FTMH. Small holes occur due to acute posterior vitreous detachment over the fovea. Spontaneous closure of stage II to stage IV holes are infrequent.(3-6%). In the inner layers of the retina the presence of a repairing glial tissue is presumed which executes centripetal traction which attracts the margin of the hole both tangentially and horizontally.

11. CONCLUSION Monitoring and follow up of the CME prevented an unnecessary surgical intervention for the patient. In whom the hole spontaneously CLOSED. Role of the topical drugs steroidal and non steroidal cannot be ruled out for the spontaneous closure. OCT is a good diagnostic tool which enables monitoring the decrease in CME and closure of macular hole. OCT is a good diagnostic tool which enables monitoring the decrease in CME and closure of macular hole. Pseudophakic macular hole with CME spontaneously closing has not been reported previously.