Macular hole closure following intravitreal triamcinolone injection in a previously vitrectomized diabetic eye

Editor, W e read with interest the article ‘Macular hole closure following intravitreal triamcinolone injection in a previously vitrectomized diabetic eye’ (Kwon et al. 2009). We would like to make an observation regarding the aetiology of macular hole closure in this case. The serial optical coherence tomography (OCT) scans of the eye show the development of a full-thickness macular hole after pars plana vitrectomy which closed spontaneously following intravitreal triamcinolone injection. Notably, the post-injection OCT scan also shows the development of an epiretinal membrane (ERM), which was not evident in the previous scans and was not mentioned by the authors. Epiretinal membrane formation is a common occurrence after pars plana vitrectomy and more so in eyes with vitreous haemorrhage. As these membranes tend to be contractile, circumferential contraction may lead to narrowing of the gap and hence aid in subsequent closure of macular hole. We found at least two case reports in which macular hole closed following ERM formation (Lewis et al. 1986; Smiddy 2008). Thus the closure of macular hole in this case may be related to the development of ERM as evident on OCT and intravitreal triamcinolone injection may have been only a coincidental event.