Sir,
I just read the case report on ‘idiopathic macular hole’ in a child in the April 2012 issue of EYE journal.1 I was surprised to see that an open-and-shut case of optic disc pit with macular schisis has been described as ‘idiopathic’ in this report.2 There is no full-thickness macular hole in the reported case; what is reported as a macular hole is actually a well-described outer retinal dehiscence (Figure 2 of the article).2, 3 Even if the pits were invisible (it is clearly visible in Figure 1 at 3:00 meridian), the tell-tale schisis on OCT gives the clue to the presence of an occult optic disc dysplasia as the cause of maculopathy.4 Therefore, this is certainly not the first report of an ‘idiopathic’ macular hole in a child, as there was neither a full-thickness hole at presentation nor was the pathology idiopathic. In fact, the surgeon created an iatrogenic macular hole (Figure 3) in this patient, a possibility that we have described previously.3 However, I agree with the surgical management of the maculopathy and suspect that the tiny postoperative macular hole might have closed subsequently.
References
Park JC, Frimpong-Ansah KN . Idiopathic macular hole in a child. Eye 2012; 26: 620–621.
Sadun AA . Optic disc pits and associated serous macular detachment. In: Ryan SJ, Schachat AP (eds). Retina 2, 4th edn. Elsevier Mosby: Philadelphia, PA; 2006. pp 1883–1889.
Shukla D, Kalliath J, Tandon M, Vijayakumar B . Vitrectomy for optic disk pit with macular schisis and outer retinal dehiscence. Retina 2012; 32: 1337–1342.
Zaidi AA, Brucker AJ, Johnson MW . Diagnostic and therapeutic challenges. Retina 2011; 31: 2125–2128.
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Shukla, D. Optic pit with macular schisis: subtle but discernible. Eye 27, 1218–1219 (2013). https://doi.org/10.1038/eye.2013.156
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DOI: https://doi.org/10.1038/eye.2013.156
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