Sir,

The natural course and prognosis of macular hole in Behçet's disease are poor.1 Here, we report about one patient with a macular hole and associated Behçet's disease who was successfully treated by vitrectomy and internal limiting membrane (ILM) peeling. The patient's vision improved subsequently.

Case report

A 42-year-old man with bilateral uveitis presented to our department with a complaint of blurred vision in the left eye (OS) for 1 year. He had a 2-year history of recurrent oral and genital ulcers. On presentation, the patient's best-corrected visual acuity was 6/15 in the right eye (OD) and 3/60 OS. Slit-lamp biomicroscopy revealed trace cells in the anterior chambers of both eyes (OU), clear lens, and 3+ cells in the vitreous OU. Indirect ophthalmoscopy revealed 1+ vitreous opacity OD, 2+ vitreous opacity OS, a mottling change of retinal pigment epithelium of macular OU, and a full-thickness macular hole OS (Figure 1a). Optic coherence tomography (OCT) showed a full-thickness macular hole and cystic oedema of the retina (Figure 1b). Behçet's disease was diagnosed based on the International Study Group for Behçet's Disease criteria.2 Treatment with corticosteroids and cyclosporin A (200 mg/day) was initiated. Pars plana vitrectomy combined with removal of the epiretinal membrane and ILM with 0.1% indocyanine green was performed. Perfluoropropane (C3F8, 16%) was injected as a gas tamponade.

Figure 1
figure 1

OCT images and fundus photographs of the patient's OS. (a and b) Preoperative fundus photograph and OCT image demonstrated a full-thickness macular hole and cystic oedema of retina. (c and d) A fundus photograph and OCT image taken 3 months postoperatively demonstrated that the macular hole was closed.

Full size image

Postoperatively, the macular hole was anatomically closed (Figure 1c). OCT confirmed successful closure and demonstrated the disappearance of the intraretinal cystoid space (Figure 1d). The visual acuity of the patient's OS had improved from 3/60 to 6/30 at 6-month follow-up.

Comments

The development of a macular hole is a rare complication of panuveitis in Behçet's disease and can ultimately lead to severe loss of vision.1 Because idiopathic macular holes rarely occur before the age of 55 years3—although we could not dispute the idiopathic origin of our case—we speculate that vitreous inflammation causing vitreous gel shrinkage and tangential traction in combination with macular oedema could cause a macular hole. The present case indicates that pars plana vitrectomy combined with ILM peeling might lead to macular hole closure with improvement in visual acuity.