Decision was made with patient to go ahead with laser treatment understanding the expected scotoma, risk to foveolar center and risk of recurrence. There was no visible PVD or pseudo-operculum. The edges of the hole were typically elevated except for the edge that had recieved photocoagulation. Fluorescein angiography showed window defect in the central foveola. Laser hypofluorescence appeared to enter the foveal avascular zone but probably not pass through its center.
Arrows indicate elevated edge of macular hole.
So far the patient has not wanted to go ahead with vitrectomy for the macular hole. This case was posted to the Vitreous Society Mailing List . The membrane contracted after the photocoagulation resulting in the macular hole. I have had one patient who I treated for idiopathic hole that developed this complication following treatment. I wondered whether I had used too much power.