Sequential multimodal imaging of isolated necrotic full-thickness macular hole secondary to toxoplasma retinochoroiditis

PURPOSE: To describe the sequential multimodal imaging features of an isolated necrotic macular hole secondary to Toxoplasma retinochoroiditis. OBSERVATION: A 23-year-old male was referred for surgical management of an idiopathic macular hole following sudden decrease in vision in his right eye. Right eye examination showed best-corrected visual acuity of 20/200, mild anterior segment inflammation, and a full thickness non operculated macular hole (MH) with ill-defined ragged margins and surrounding strip of pallid edema. Further multimodal imaging including optical coherence tomography (OCT), fundus autofluorescence (FAF), fluorescein angiography (FFA), and OCT-angiography confirmed the atypical configuration and inflammatory nature of MH. Serological tests showed elevated level of Toxoplasma gondii-specific antibodies. A diagnosis of necrotic isolated full-thickness MH secondary to toxoplasma retinochoroiditis was made. Patient was treated medically with anti-toxoplasma medication for 6 months. Sequential multimodal imaging highlighted the healing process of necrotic MH with vision improving to 20/80 at 6 months after presentation. CONCLUSION AND IMPORTANCE: A high level of suspicion and multimodal imaging plays an important role in accurate etiological diagnosis and management of atypical macular hole as in our case. Sequential multimodal imaging may provide an insight into the pathogenesis and healing pattern of such lesion.