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.