Vertical Internal Limiting Membrane Stalk after Macular Hole Surgery

A 62-year-old White woman with a 441-μm wide full-thickness macular hole had a vitrectomy with a temporal inverted internal limiting membrane (ILM) flap in her left eye. After the 6-month follow-up visit, her vision improved to 20/80 with substantially reduced metamorphopsia. She presented with a newly emerged, immobile "dark obscuration" in the center of her visual field. On OCT examination, the macular hole was closed with a complete reconstitution of banded anatomy. A vertical 1.19-mm–long ILM stalk extended from the foveal depression that produced shadowing of underlying layers. A retrospective analysis of images acquired at 1 month and 3 months revealed an asymptomatic gradual rearrangement of the ILM. The patient declined to undergo another intraocular surgery to eliminate the postoperative ILM structure (Magnified version of Fig 1 is available online at www.aaojournal.org).