Vitrectomy with amniotic membrane transplantation for macular choroidal coloboma with macular hole and posterior scleral staphyloma: a case report

Background: This study aimed to report a case of vitrectomy with amniotic membrane transplantation (AMT) for a macular choroidal coloboma (CC) associated with a macular hole (MH) and posterior scleral staphyloma (PSS). Case presentation: A 54-year-old woman presented with a 10-day history of decreased vision and metamorphopsia in her right eye. Other than bilateral cataracts, no other ocular abnormalities were found. The best-corrected visual acuity (BCVA) was 0.05 in the right eye and 0.5 in the left eye. Scanning laser ophthalmoscopy (SLO) revealed an atrophic-like lesion and an MH in the macular area. Optical coherence tomography (OCT) revealed a macular CC with a full-thickness MH and PSS. Due to the large size of the MH(1238 × 976 μm) and significant ocular symptoms, the patient underwent vitrectomy with internal limiting membrane (ILM) peeling, AMT, and silicone oil tamponade (SOT). At the 3-month follow-up, the amniotic membrane (AM) was functioning, but the condition had not yet stabilized. During the subsequent silicone oil removal (SOR) procedure, a second AMT was performed, followed by an intravitreal injection of C3F8 gas. At 9 months after SOR, OCT demonstrated firm adhesion between the AM, the edges of the MH, and the sclera. The MH showed signs of stability, and the cavity formed by the CC and PSS had decreased in size. In parallel with the anatomical improvement, the patient's visual quality improved. Conclusion: We report a rare surgical case of a macular CC with an MH and PSS. Surgery resulted in improvements in both anatomic architecture and visual quality. This case expands our understanding of the pathogenesis and management of this uncommon disease.