Posterior placoid-like maculopathy and macular hole associated with vitamin A deficiency

PURPOSE: To report a case of bilateral posterior placoid-like maculopathy and a macular hole associated with vitamin A deficiency. OBSERVATIONS: A 72-year-old male presented with nyctalopia and progressive vision loss in both eyes. Examination and multimodal imaging were consistent with posterior placoid-like maculopathy bilaterally and a macular hole in the right eye. A workup for infectious, inflammatory, and paraneoplastic etiologies revealed a severely low serum vitamin A level. Two months after initiation of vitamin A repletion, there was improvement in best-corrected Snellen visual acuity as well as macular hole closure. A diagnosis of posterior placoid-like maculopathy in the setting of vitamin A deficiency (VAD) was made. CONCLUSIONS AND IMPORTANCE: VAD should be considered when symmetric posterior pole placoid-like lesions are observed and other, more common etiologies have been ruled out.