Resolution of postoperative macular hole with topical nepafenac: a case report

Abstract

PurposeMacular hole (MH) is a rare complication of cataract extraction. Various etiologies are discussed but it seems that the combination of vitreous traction and pseudophakic macular edema are the causes most likely involved in its pathogenesis. Pars plana vitrectomy (PPV) and internal limiting membrane peeling is the gold standard treatment option for patients with postoperative MH. Medical treatment has not been very effective in resolving this pathology. We present a case of post‐surgical MH treated with topical Nepafenac.MethodsInterventional case report showing the role of topical Nepafenac as a therapeutic tool in post‐surgical MH.ResultsAn 81‐year‐old female with a history of uncomplicated cataract surgery in RE. Four weeks after surgery there was a progressive visual deterioration with a best corrected visual acuity (BCVA): 0.05. SD‐OCT revealed a full‐thickness MH. Nepafenac 0.1 mg/ml, 3 times a day, was administered for 8 weeks in RE. Four months later, an improvement of her visual acuity (BCVA: 0.4) and a recovery of the retinal structure were observed. No recidive has been observed in a follow‐up of 1 year.ConclusionsWe propose the therapeutic use of topical NSAIDs as a possible alternative to surgery for macular holes whose etiology is related to inflammatory processes.

Two Cases of Macular Hole Closure with Topical Medical Treatment

“…1 e ). Although PPV and ILM peeling are considered the gold standard treatment for FTMHs by liberating anterior-posterior and tangential traction from the hole, recent reports have raised the possibility of treating smaller macular holes only with topical therapy 6 , 7 , 8 , 9 . It has been suggested that some macular holes, such as secondary FTMHs, may form without vitreous or membrane traction 6 .…”

Closure of Full-Thickness Macular Holes Associated with Macular Edema with Medical Therapy

“…Macular hole closure with medical therapy was first reported by Halkiadakis et al [11] in a patient with active uveitis related to HLA-B27 treated with peribulbar triamcinolone injections. Other medical treatments reported to close macular holes include topical nonsteroidal antiinflammatory drugs [2][3][4], topical steroids [5, 6], topical carbonic anhydrase inhibitors [7][8][9], and oral carbonic anhydrase inhibitor [10]. In this series 2 patients received intravitreal medications as part of their medical treatment for macular holes.…”

“…Because of the need to relieve traction and the need to provide intraocular tamponade, most macular holes are treated surgically with vitrectomy. Medical therapy has been reported mostly in case reports and small series to allow closure of macular holes without surgery [2][3][4][5][6][7][8][9][10][11]. Herein, this series of cases of successful macular hole closure with medical therapy without surgery was studied to better understand the size of the holes closed, the factors associated with…”