Macular hole with inner limiting membrane peeling off spontaneously in Terson syndrome: A case report

INTRODUCTION: Terson's syndrome with inner limiting membrane (ILM) peeled off spontaneously is rarely seen, and the mechanism of it is not clear. Here we report a case of Terson Syndrome with a rare finding: the ILM peeled off spontaneously associated with macular hole (MH). PATIENT CONCERNS: A 36-year-old female patient was admitted to our hospital with decreased visual acuity in the right eye lasting for 1 month. She just had surgery for subarachnoid hemorrhage that occurred 1 month before due to the rupture of the intracranial aneurysm. DIAGNOSIS: Terson syndrome was diagnosed according to her medical history and examination. A partial posterior vitreous detachment (PVD) and dense vitreous hemorrhage (VH) was confirmed in the right eye by performing ophthalmic B-scan ultrasonography examination. Head computed tomography showed the subarachnoid hemorrhage after aneurysmal rupture. INTERVENTIONS: The patient underwent pars plana vitrectomy in her right eye to remove the VH. After removal of the VH, a full-thickness macular hole was noted with the ILM peeled off spontaneously. So we conducted gas tamponade, and face-down positioning after pas plana vitrectomy. OUTCOMES: At two weeks follow-up, her best corrected visual acuity was 0.15 in the right eye. Spectral domain optical coherence tomography showed that the MH was closed completely, while the thickness of the nasal retina of the foveal was thicker than that on the temporal side. LESSONS: ILM peeled off spontaneously associated with MH is a rarely seen complication of Terson Syndrome. Due to the large-scale of the ILM peeling off, final visual acuity may be poor in patients, even though successful macular hole closure after the operation.