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Multiple extrafoveal macular holes following internal limiting membrane peeling

Authors Hussain N, Mitra S

Received 25 January 2018

Accepted for publication 17 March 2018

Published 1 May 2018 Volume 2018:11 Pages 105—111

DOI https://doi.org/10.2147/IMCRJ.S163780

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Nazimul Hussain, Sandip Mitra

Department of Ophthalmology, Al Zahra Hospital, Sharjah, United Arab Emirates


Objective: Internal limiting membrane (ILM) peeling has been the standard of treatment for macular holes. Besides, causing retinal nerve fiber layer surface abnormality, postoperative extrafoveal multiple retinal holes is a rare phenomenon following ILM peeling. We report an unusual complication of eight extrafoveal macular holes occurring following ILM peeling.
Case presentation: A 60-year-old male presented with complaints of decreased and distorted vision in the right eye. He was diagnosed as having epiretinal membrane with lamellar macular hole. He underwent 23G pars plana vitrectomy, brilliant blue assisted ILM peeling and fluid gas exchange. Intraoperatively, ILM was found to be adherent to the underlying neurosensory retina. One month after cataract surgery, he underwent YAG capsulotomy in the right eye. He complained of visual distortion. His fundus evaluation in the right eye showed multiple (eight) extrafoveal retinal holes temporal to the macula clustered together.
Conclusion: This case demonstrated that peeling of ILM, especially when it is adherent to the underlying neurosensory retina, may cause unwanted mechanical trauma to the inner retina. Glial apoptosis and neuronal degeneration may presumably play a role in delayed appearance of multiple (eight) extrafoveal macular holes, which has not been reported earlier.

Keywords: internal limiting membrane, lamellar macular hole, full thickness macular holes, epiretinal membrane

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