Spontaneous closure of secondary full-thickness macular hole following pars plana vitrectomy for rhegmatogenous retinal detachment: a case report and literature review

Secondary full-thickness macular holes (sFTMHs) are rare complications following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). Although surgical repair is standard, spontaneous closure occurs in a minority of cases. This report describes a case of spontaneous sFTMH closure and reviews the literature to elucidate associated factors and mechanisms.

We present a case of a 33-year-old male who developed a sFTMH after silicone oil removal following PPV for RRD. Additionally, a comprehensive PubMed literature search identified published cases of spontaneous sFTMH closure after RRD repair.

The patient's sFTMH closed spontaneously within three months, accompanied by improved visual acuity. A review of over 30 published cases reveals distinct pathogenic and resolution factors. Hole formation is driven by postoperative tangential traction from epiretinal membranes (ERM), cystoid macular edema (CME), surgical trauma, and inflammation, with high-altitude exposure as a notable environmental risk. Conversely, spontaneous closure is favored by a smaller hole diameter and the presence of epiretinal proliferation (EP) which may act as a scaffold for glial bridging, and often coincides with CME resolution, potentially accelerated by topical therapy. Mechanistically, closure is mediated by glial proliferation and tissue apposition under persistent epiretinal traction, combined with intraretinal fluid resorption, leading to variable restoration of the retinal laminar structure.

Spontaneous closure of sFTMHs after RRD surgery is a recognized phenomenon. For selected patients with small, minimally symptomatic holes associated with edema or EP, initial management with observation, potentially supplemented by topical therapy, is a viable strategy before considering surgery.