Unique presentation of high-density Material as a precursor to full-thickness macular hole development: A case report

Unique presentation of high-density Material as a precursor to full-thickness macular hole development: A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Unique presentation of high-density Material as a precursor to full-thickness macular hole development: A case report Jiasheng Liu, Lei Huang, Pengfei Yang, Shanna Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8002221/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background： Full-thickness macular hole (FTMH) is a full-thickness defect of retinal tissue, which affects the central visual acuity by involving the fovea. We report a unique case in which high-density material in the fovea preceded the development of a FTMH, highlighting a potential early indicator of structural compromise. Case presentation: A 50s female presented with decreased visual acuity in the right eye. Fundoscopic examination and optical coherence tomography (OCT) revealed high-density material at the fovea, with subsequent progression to a FTMH. The patient was managed conservatively initially, with close monitoring,and later considered for surgical intervention.Postoperatively, the FTMH closed, and despite transient subretinal fluid, the ellipsoid zone（EZ）was nearly restored. Visual acuity improved and remained stable at the 3-year follow-up. Conclusions: This case underscores the importance of recognizing atypical foveal changes, such as high-density material, as potential precursors to FTMH. Early detection using OCT and timely intervention are critical for optimizing visual outcomes. Further research is needed to elucidate the role of such material in macular hole pathogenesis. Full-thickness macular hole Macular hole high-density material optical coherence tomography Figures Figure 1 Background Macular hole(MH)is a full-thickness defect involving the anatomical fovea retina, which affects the central visual acuity of the patient[ 2 ].It is more common in elderly females and is often associated with vitreomacular traction and age-related vitreous changes[ 3 ].While spontaneous closure occurs in a small percentage of cases, most require surgical intervention to prevent progressive visual decline[ 2 ]. Diagnostic challenges often arise in distinguishing FTMH from lamellar hole or pseudohole, necessitating advanced imaging such as OCT[ 4 , 5 ]. We present a case in which high-density material in the fovea was observed prior to the development of a FTMH, suggesting a novel pathophysiological pathway and emphasizing the need for heightened diagnostic awareness. Case description A woman in her 50s with a history of diabetes mellitus and proliferative diabetic retinopathy presented with a two-month history of blurred vision in her right eye (OD). She had undergone Panretinal photocoagulation(PRP) in the same eye three years earlier, at which time her best-corrected visual acuity (BCVA) was 20/32. At presentation, her uncorrected distance visual acuity (UDVA) was 20/63 and BCVA was 20/50. Fundus examination with Optos revealed laser scars consistent with previous PRP (Fig. 1 A). OCT showed high-density material within the macular area (Fig. 1 B). The patient opted for clinical observation. One month later, follow-up OCT showed a reduction in the high-density material (Fig. 1 C). Three weeks thereafter, OCT revealed prolapse of the material and formation of a full-thickness macular hole with a horizontal diameter of 260 µm (Fig. 1 D). Visual acuity declined to UDVA 20/200 and BCVA 20/100. After discussion, the patient underwent combined phacoemulsification, 25-gauge pars plana vitrectomy, inverted internal limiting membrane flap technique, and 12% C3F8 gas tamponade. Two weeks postoperatively, OCT confirmed MH closure (Fig. 1 E). One month post-surgery, OCT showed subretinal fluid (SRF, Fig. 1 F), which resolved by five months, with near-complete ellipsoid zone (EZ) restoration (Fig. 1 G). At the final follow-up three years postoperatively, visual acuity (UDVA and BCVA both 20/40) and macular structure remained stable (Fig. 1 H). Discussion and Conclusions This case illustrates an unusual presentation of FTMH, where high-density foveal material appeared to precede hole formation. Unlike typical cases associated with vitreomacular traction, this presentation suggests an alternative mechanism, possibly related to localized metabolic or structural changes in the fovea. A FTMH was previously observed in a patient 1 month after panretinal photocoagulation[ 1 ], but there have been no reports of MH 3 years after panretinal photocoagulation. The early reason why we take conservative treatment of MH is because there is a high-density material in the MH, we speculate that this is the the filling of secretion of Müller cells, which is a kind of self-protection of the body.From histological perspective, the macular fovea is mainly composed of photoreceptor cells and Müller cell cones. The Müller cell cones cover the axons of photoreceptor cells. The stability of the macular fovea structure is provided by Müller cells[ 6 ].When the traction force acting on the fovea is enhanced. It may be that the bottom of the Müller cell cone is pulled and disengaged due to the inability to resist the centrifugal force of the inner layer of the retinal[ 7 ].The shank of the Müller cell cone may be damaged due to the inability to continue to maintain mechanical stability in the vertical direction. In the end, compensatory stretching and straightening of Müller cells could not maintain mechanical stability of the retina, causing the formation of MH[ 8 ]. Meanwhile, the accumulation of such material may represent an early sign of foveal compromise, warranting closer surveillance and potentially earlier intervention. OCT remains indispensable in detecting these subtle changes and differentiating them from other pathologies such as cystoid macular edema or epiretinal membrane.While this report adds to the growing literature on atypical macular hole presentations, its single-case nature limits generalizability. Future studies should aim to characterize the composition of high-density foveal material and its role in macular hole pathogenesis. Longitudinal imaging and histopathological correlation may provide further insights. In conclusion, clinicians should consider high-density foveal material as a potential precursor to FTMH. Enhanced recognition and early referral for OCT evaluation may facilitate timely management and improve visual prognosis. Abbreviations BCVA Best-corrected visual acuity EZ Ellipsoid zone FTMH Full-thickness macular hole MH Macular hole OCT Optical coherence tomography SRF Subretinal fluid UDVA Uncorrected distance visual acuity Declarations Acknowledgements We thank Ryan Chastain-Gross, from Liwen Bianji, Edanz Editing China (www.liwenbianji.cn), for editing the English text of a draft of this manuscript. Author Contributions Jiasheng Liu was responsible for drafting of the text. Shanna Chen，Jiasheng Liu，Lei Huang and Pengfei Yang were responsible for sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms. Shanna Chen supervised the project. All authors agreed to submission of the manuscript in its final form. Funding None. Data Availability Statement Not applicable. Ethics approval and consent to participate We affirm that the patient has provided written consent for utilizing their clinical data, examination results, and imaging findings to support diagnosis, education, research, and quality enhancement efforts. Consent for publication Written informed consent was obtained from the individual for the publication of any potentially identifiable images or data included in this article. Competing interests The authors have no conflicts of interest to declare. References Kumar V, Surve A, Mondal S, Azad SV. Macular hole formation following panretinal photocoagulation in proliferative diabetic retinopathy. BMJ Case Rep. 2021;14(2). 10.1136/bcr-2020-240730 . Landolfi M, Zarbin MA, Bhagat N. Macular holes. Ophthalmol Clin North Am. 2002;15(4):565–72. 10.1016/s0896-1549(02)00047-0 . Ho AC, Guyer DR, Fine SL. Macular hole. Surv Ophthalmol. 1998;42(5):393–416. 10.1016/s0039-6257(97)00132-x . Hubschman JP, Govetto A, Spaide RF, Schumann R, Steel D, Figueroa MS, et al. Optical coherence tomography-based consensus definition for lamellar macular hole. Br J Ophthalmol. 2020;104(12):1741–7. 10.1136/bjophthalmol-2019-315432 . Chehaibou I, Philippakis E, Mané V, Lavia C, Couturier A, Gaudric A, et al. Surgical outcomes in patients with lamellar macular holes selected based on the optical coherence tomography consensus definition. Int J Retina Vitreous. 2021;7(1):31. 10.1186/s40942-021-00297-6 . Bringmann A, Syrbe S, Görner K, Kacza J, Francke M, Wiedemann P, et al. The primate fovea: Structure, function and development. Prog Retin Eye Res. 2018;66:49–84. 10.1016/j.preteyeres.2018.03.006 . Gass JD. Müller cell cone, an overlooked part of the anatomy of the fovea centralis: hypotheses concerning its role in the pathogenesis of macular hole and foveomacualr retinoschisis. Arch Ophthalmol. 1999;117(6):821–3. 10.1001/archopht.117.6.821 . Bringmann A, Unterlauft JD, Wiedemann R, Rehak M, Wiedemann P. Morphology of partial-thickness macular defects: presumed roles of Müller cells and tissue layer interfaces of low mechanical stability. Int J Retina Vitreous. 2020;6:28. 10.1186/s40942-020-00232-1 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8002221","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":554750893,"identity":"2506e3b2-17c8-48e7-8e40-c87550e7bfb7","order_by":0,"name":"Jiasheng Liu","email":"","orcid":"","institution":"Xiamen Kehong Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiasheng","middleName":"","lastName":"Liu","suffix":""},{"id":554750896,"identity":"001de65f-2323-4329-a44b-3d315d7839a1","order_by":1,"name":"Lei Huang","email":"","orcid":"","institution":"Xiamen Kehong Eye 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14:15:46","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":32215,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8002221/v1/1a24e7bcaae5d497d5ec1fd7.html"},{"id":97454777,"identity":"81d549ee-3349-44cb-a70d-c11540684501","added_by":"auto","created_at":"2025-12-04 14:15:46","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":510717,"visible":true,"origin":"","legend":"\u003cp\u003eA: Fundus manifestations after panretinal photocoagulation in the right eye; B: High-density material located in the MH; C: Some high-density material is present in the MH, with a horizontal diameter of 343 µm. D: The high-density material is completely detached and a complete MH is evident, with a horizontal diameter of 260 µm. E: OCT examination results at 2 weeks postoperatively. F: Partial SRF remains visible present. G: SRF disappeared, and EZ repair was slightly incomplete. H: OCT 3 years postoperatively. Scale bars in B—H = 200 µm.\u003c/p\u003e","description":"","filename":"Figure.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8002221/v1/ea8b4b327bc554c2792dd401.jpg"},{"id":100487283,"identity":"8f6ae25b-22f3-40d5-be14-257857e05d7a","added_by":"auto","created_at":"2026-01-17 17:38:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":862264,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8002221/v1/48750be5-0df2-4ec4-b1c2-b9d2cdb3f448.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unique presentation of high-density Material as a precursor to full-thickness macular hole development: A case report","fulltext":[{"header":"Background","content":"\u003cp\u003eMacular hole(MH)is a full-thickness defect involving the anatomical fovea retina, which affects the central visual acuity of the patient[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].It is more common in elderly females and is often associated with vitreomacular traction and age-related vitreous changes[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].While spontaneous closure occurs in a small percentage of cases, most require surgical intervention to prevent progressive visual decline[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDiagnostic challenges often arise in distinguishing FTMH from lamellar hole or pseudohole, necessitating advanced imaging such as OCT[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. We present a case in which high-density material in the fovea was observed prior to the development of a FTMH, suggesting a novel pathophysiological pathway and emphasizing the need for heightened diagnostic awareness.\u003c/p\u003e"},{"header":"Case description","content":"\u003cp\u003eA woman in her 50s with a history of diabetes mellitus and proliferative diabetic retinopathy presented with a two-month history of blurred vision in her right eye (OD). She had undergone Panretinal photocoagulation(PRP) in the same eye three years earlier, at which time her best-corrected visual acuity (BCVA) was 20/32. At presentation, her uncorrected distance visual acuity (UDVA) was 20/63 and BCVA was 20/50.\u003c/p\u003e\u003cp\u003eFundus examination with Optos revealed laser scars consistent with previous PRP (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). OCT showed high-density material within the macular area (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). The patient opted for clinical observation. One month later, follow-up OCT showed a reduction in the high-density material (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC). Three weeks thereafter, OCT revealed prolapse of the material and formation of a full-thickness macular hole with a horizontal diameter of 260 \u0026micro;m (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD). Visual acuity declined to UDVA 20/200 and BCVA 20/100.\u003c/p\u003e\u003cp\u003eAfter discussion, the patient underwent combined phacoemulsification, 25-gauge pars plana vitrectomy, inverted internal limiting membrane flap technique, and 12% C3F8 gas tamponade. Two weeks postoperatively, OCT confirmed MH closure (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eE). One month post-surgery, OCT showed subretinal fluid (SRF, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eF), which resolved by five months, with near-complete ellipsoid zone (EZ) restoration (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eG). At the final follow-up three years postoperatively, visual acuity (UDVA and BCVA both 20/40) and macular structure remained stable (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eH).\u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eThis case illustrates an unusual presentation of FTMH, where high-density foveal material appeared to precede hole formation. Unlike typical cases associated with vitreomacular traction, this presentation suggests an alternative mechanism, possibly related to localized metabolic or structural changes in the fovea.\u003c/p\u003e\u003cp\u003eA FTMH was previously observed in a patient 1 month after panretinal photocoagulation[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], but there have been no reports of MH 3 years after panretinal photocoagulation. The early reason why we take conservative treatment of MH is because there is a high-density material in the MH, we speculate that this is the the filling of secretion of M\u0026uuml;ller cells, which is a kind of self-protection of the body.From histological perspective, the macular fovea is mainly composed of photoreceptor cells and M\u0026uuml;ller cell cones. The M\u0026uuml;ller cell cones cover the axons of photoreceptor cells. The stability of the macular fovea structure is provided by M\u0026uuml;ller cells[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].When the traction force acting on the fovea is enhanced. It may be that the bottom of the M\u0026uuml;ller cell cone is pulled and disengaged due to the inability to resist the centrifugal force of the inner layer of the retinal[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].The shank of the M\u0026uuml;ller cell cone may be damaged due to the inability to continue to maintain mechanical stability in the vertical direction. In the end, compensatory stretching and straightening of M\u0026uuml;ller cells could not maintain mechanical stability of the retina, causing the formation of MH[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMeanwhile, the accumulation of such material may represent an early sign of foveal compromise, warranting closer surveillance and potentially earlier intervention. OCT remains indispensable in detecting these subtle changes and differentiating them from other pathologies such as cystoid macular edema or epiretinal membrane.While this report adds to the growing literature on atypical macular hole presentations, its single-case nature limits generalizability. Future studies should aim to characterize the composition of high-density foveal material and its role in macular hole pathogenesis. Longitudinal imaging and histopathological correlation may provide further insights.\u003c/p\u003e\u003cp\u003eIn conclusion, clinicians should consider high-density foveal material as a potential precursor to FTMH. Enhanced recognition and early referral for OCT evaluation may facilitate timely management and improve visual prognosis.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBCVA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBest-corrected visual acuity\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEZ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEllipsoid zone\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFTMH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFull-thickness macular hole\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMacular hole\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOptical coherence tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSRF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSubretinal fluid\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUDVA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUncorrected distance visual acuity\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Ryan Chastain-Gross, from Liwen Bianji, Edanz Editing China (www.liwenbianji.cn), for editing the English text of a draft of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJiasheng Liu was responsible for drafting of the text. Shanna Chen，Jiasheng Liu，Lei Huang and Pengfei Yang were responsible for sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms. Shanna Chen supervised the project. All authors agreed to submission of the manuscript in its final form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe affirm that the patient has provided written consent for utilizing their\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eclinical data, examination results, and imaging findings to support diagnosis, education, research, and quality enhancement efforts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc472330565\"\u003eWritten informed consent was obtained from the individual for the publication of any potentially identifiable images or data included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKumar V, Surve A, Mondal S, Azad SV. Macular hole formation following panretinal photocoagulation in proliferative diabetic retinopathy. BMJ Case Rep. 2021;14(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bcr-2020-240730\u003c/span\u003e\u003cspan address=\"10.1136/bcr-2020-240730\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLandolfi M, Zarbin MA, Bhagat N. Macular holes. Ophthalmol Clin North Am. 2002;15(4):565\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0896-1549(02)00047-0\u003c/span\u003e\u003cspan address=\"10.1016/s0896-1549(02)00047-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHo AC, Guyer DR, Fine SL. Macular hole. Surv Ophthalmol. 1998;42(5):393\u0026ndash;416. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0039-6257(97)00132-x\u003c/span\u003e\u003cspan address=\"10.1016/s0039-6257(97)00132-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHubschman JP, Govetto A, Spaide RF, Schumann R, Steel D, Figueroa MS, et al. Optical coherence tomography-based consensus definition for lamellar macular hole. Br J Ophthalmol. 2020;104(12):1741\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bjophthalmol-2019-315432\u003c/span\u003e\u003cspan address=\"10.1136/bjophthalmol-2019-315432\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChehaibou I, Philippakis E, Man\u0026eacute; V, Lavia C, Couturier A, Gaudric A, et al. Surgical outcomes in patients with lamellar macular holes selected based on the optical coherence tomography consensus definition. Int J Retina Vitreous. 2021;7(1):31. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40942-021-00297-6\u003c/span\u003e\u003cspan address=\"10.1186/s40942-021-00297-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBringmann A, Syrbe S, G\u0026ouml;rner K, Kacza J, Francke M, Wiedemann P, et al. The primate fovea: Structure, function and development. Prog Retin Eye Res. 2018;66:49\u0026ndash;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.preteyeres.2018.03.006\u003c/span\u003e\u003cspan address=\"10.1016/j.preteyeres.2018.03.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGass JD. M\u0026uuml;ller cell cone, an overlooked part of the anatomy of the fovea centralis: hypotheses concerning its role in the pathogenesis of macular hole and foveomacualr retinoschisis. Arch Ophthalmol. 1999;117(6):821\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/archopht.117.6.821\u003c/span\u003e\u003cspan address=\"10.1001/archopht.117.6.821\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBringmann A, Unterlauft JD, Wiedemann R, Rehak M, Wiedemann P. Morphology of partial-thickness macular defects: presumed roles of M\u0026uuml;ller cells and tissue layer interfaces of low mechanical stability. Int J Retina Vitreous. 2020;6:28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40942-020-00232-1\u003c/span\u003e\u003cspan address=\"10.1186/s40942-020-00232-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Full-thickness macular hole, Macular hole, high-density material, optical coherence tomography","lastPublishedDoi":"10.21203/rs.3.rs-8002221/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8002221/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground：\u003c/strong\u003eFull-thickness macular hole (FTMH) is a full-thickness defect of retinal tissue, which affects the central visual acuity by involving the fovea. We report a unique case in which high-density material in the fovea preceded the development of a FTMH, highlighting a potential early indicator of structural compromise.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation: \u003c/strong\u003eA 50s female presented with decreased visual acuity in the right eye. Fundoscopic examination and optical coherence tomography (OCT) revealed high-density material at the fovea, with subsequent progression to a FTMH. The patient was managed conservatively initially, with close monitoring,and later considered for surgical intervention.Postoperatively, the FTMH closed, and despite transient subretinal fluid, the ellipsoid zone（EZ）was nearly restored. Visual acuity improved and remained stable at the 3-year follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003eThis case underscores the importance of recognizing atypical foveal changes, such as high-density material, as potential precursors to FTMH. Early detection using OCT and timely intervention are critical for optimizing visual outcomes. Further research is needed to elucidate the role of such material in macular hole pathogenesis.\u003c/p\u003e","manuscriptTitle":"Unique presentation of high-density Material as a precursor to full-thickness macular hole development: A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-04 14:15:41","doi":"10.21203/rs.3.rs-8002221/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f2f1cc56-fdff-4494-84ad-422a210825a3","owner":[],"postedDate":"December 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-17T17:38:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-04 14:15:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8002221","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8002221","identity":"rs-8002221","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}