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Idiopathic horseshoe-like macular tear: a case report

Authors Kubota M, Shibata T, Gunji H, Tsuneoka H

Received 27 October 2015

Accepted for publication 4 February 2016

Published 28 July 2016 Volume 2016:9 Pages 219—222

DOI https://doi.org/10.2147/IMCRJ.S99230

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Nitesh Kuhadiya

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Masaomi Kubota,1 Tomohiro Shibata,1 Hisato Gunji,1 Hiroshi Tsuneoka2

1Department of Ophthalmology, The Jikei University School of Medicine Kashiwa Hospital, Chiba, 2Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan

Background: Although a few cases with idiopathic horseshoe-like macular tear have been reported, the mechanism remains unknown and a standard treatment has yet to be determined.
Objective: To report the outcome for a patient with idiopathic horseshoe-like macular tear who underwent vitreous surgery.
Case report: A 65-year-old man with no previous injury or ophthalmic disease presented with abnormal vision in his left eye. Best-corrected visual acuity was 0.8 in the right and 0.3 in the left, and the relative afferent pupillary defect was negative. Ophthalmoscopy revealed a horseshoe-like tear on the temporal side of the macula in the left eye. The tear size was 0.75 disc diameters (DD). Optical coherence tomography showed that the focal retinal detachment reached the fovea. A few days after the first visit, there was no longer adhesion of the flap of the tear to the retina and the tear size had increased to 1.5 DD. The patient underwent vitreous surgery similar to large macular hole surgery, with the tear closure repaired using the inverted internal limiting membrane flap technique with 20% SF6 gas tamponade. Although the tear decreased to 0.5 DD after the surgery, complete closure of the tear was not achieved.
Conclusion: While cases with horseshoe-like macular tear following trauma and branch retinal vein occlusion have been reported, to the best of our knowledge, this is the first reported idiopathic case. In the present case, there was expansion of the tear until the patient actually underwent surgery. If vertical vitreous traction indeed plays a role in horseshoe-like macular tears, this will need to be taken into consideration at the time of the vitreous surgery in these types of cases.

Keywords: horseshoe-like macular tear, vitreous surgery, retinal detachment, vitreous traction

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