Background: Macular hole (MH) is a retinal break in the fovea involving partial or complete dehiscence of the\nneural retinal layers affecting the visual quality by decreasing visual acuity (VA) and visual deformation. We describe\na case of secondary MH associated with submacular hemorrhage (SMH) due to polypoidal choroidal vasculopathy\n(PCV), which showed spontaneous closure.\nCase presentation: A 67-year-old man developed decreased VA in his right eye due to an SMH. The VA was 20/50,\nand monthly intravitreal injection of aflibercept was administered three times. The SMH gradually decreased, and\n10 months later the external limiting membrane was found to be perforated, resulting in MH. The old clot\ndisappeared, and the MH remained for 10 months. Twenty-three months later, serous retinal detachment (SRD)\ninvolving the macula appeared and the MH had disappeared. SRD gradually disappeared, and macular\nconfiguration recovered. VA gradually improved and became 20/20 38 months later.\nConclusion: Dynamic change of the ultrastructure in an unusual case of secondary-developed and spontaneously\nclosed MH was clearly observed. Although the mechanism was unknown, the small diameter size and exudative\nPCV are thought to have contributed to the closure.
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