A variety of precipitating factors have been described for full-thickness macular holes. To the best of our knowledge, full-thickness macular holes after air puff tonometry have not previously been described in the literature. We present a rare case of full-thickness macular holes caused by air puff tonometry.
Royal Eye Infirmary, Derriford Hospital, Plymouth
A 66-year-old male with bilateral pseudophakia presented to his optometrist with a visual acuity of 6/6 in both eyes. Following air puff tonometry, he immediately noticed reduced vision in his left eye. On immediate rechecking, his left eye visual acuity had reduced to 6/24. He was then seen in the emergency eye clinic. A fundal examination of his left eye showed a full-thickness macular hole. Based on optical coherence tomography, a stage 2 full-thickness macular hole was confirmed.
After a period of observation of 5 weeks, the patient's vision had deteriorated to 6/60 in the left eye. He was treated successfully with vitrectomy, internal limiting membrane peel, with cryo-retinopexy and gas tamponade. The final visual acuity of the patient was 6/24.
This is the first case demonstrating the possible role of air puff tonometry in precipitating the formation of a full-thickness macular hole. It is imperative that machines using this method are regularly calibrated and serviced so that they use the lowest and safest air pressures necessary to determine intraocular pressure.
No conflict of any interest
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