Spontaneous Combined Full-Thickness Retinal and Pigment Epithelium Macular Hole in Age-Related Macular Degeneration

The authors describe a case of combined full-thickness retinal and pigment epithelium macular hole that spontaneously developed in the right eye of an 86-year-old woman with age-related macular degeneration (AMD). One year prior, the patient had been diagnosed with drusenoid pigment epithelium detachment (PED) in the right eye and geographic atrophy in the left eye. Full-thickness macular hole associated with PED and spontaneous rip of the retinal pigment epithelium (RPE) associated with macular hole have been previously reported in eyes with exudative AMD. However, the authors are unaware of any report of spontaneous full-thickness retinal and pigment epithelium hole at the macula in AMD. The pathogenic mechanisms of this unusual macular hole, which involves the full retinal thickness and RPE, may include stretching forces at the vitreomacular interface and pushing from within the PED.