Purpose: To report a case of spontaneous closure of macular lamellar hole, and to discuss its probable mechanisms. Case Report: A 70-year-old woman with a diagnosis of SLE and chronic usage of hydroxychloroquine, presented to our clinic for routine retinal examinations. Her best corrected visual acuity was 7. 10 in both eyes, with a senile lens opacity and no sign of retinal HCQ toxicity. On examination and macular OCT of her left eye, a thick epiretinal membrane with the adjacent lamellar hole was detected. As there were no indications for surgical intervention, she was followed without any treatment. On 1-year follow-up examination, the ERM was seen but the hole was closed, and macular OCT of the left eye approved spontaneous closure of the hole. Conclusion: Herein we report a case of spontaneous resolution of the macular lamellar hole, an event not reported in the literature, in addition to presenting a brief review on pathophysiology and treatment of ERM and lamellar holes. Although the resolution of retinal edema or change in ERM can alter tractional features of a macular hole resembling spontaneous whole closure, in our case there was no retinal edema, and the epiretinal membrane showed no change on follow-up examinations.

Purpose: To evaluate the effect of intraviteral bevacizumab (IVB) in diabetic macular edema (DME), using multifocal electroretinography (mfERG).Methods: Sixty-four eyes of 32 patients with bilateral symmetric clinically significant macular edema (CSME) were included in the study. After taking a baseline mfERG, macular photocoagulation (MPC) was done in all eyes. After 7 days, 1.25 mg of bevacizumab was randomly injected in one eye of each patient and the other eye assigned for sham injection. mfERG was repeated 8 weeks after injection, and changes in visual acuity and mfERG compared in two groups. Results: The mean best corrected visual acuities (BCVAs) at baseline were 0.55 in IVB group and 0.51 in control group and at 8th week were 0.41 and 0.53 respectively, also the amplitude and implicit time showed significant improvement in mfERG. Significant improvement in visual acuity and amplitude of waves of mfERG were observed compared with sham group. Conclusion: IVB injection can augment the effect of MPC in DME and can be used as an adjunctive treatment in these cases.

Cystoid macular edema (CME) is a painless disease with different etiologies, which manifests as multiple cyst like (cystoid) spaces in the macula. CME is a common cause of vision loss following cataract surgery. Some risk factors for post-cataract surgery CME include intraoperative complications specially incarceration of vitreous in the surgical wound, history of diabetes, uveitis and postoperative inflammation and infection. Clinical examination, fluorescein angiography and OCT are beneficial in the diagnosis of this disease. Since, it is a self-limiting disease, no standard therapy has been developed despite topical NSAIDs, periocular and intravitreal steroid injection and oral carbonic anhydrase inhibitors are used in chronic cases.

Sir, Recently Bonyadi [1] described the case of a 30‑ year‑ old man who lost vision in the left eye following trauma due to an explosion of a vehicle tire tube. Optical coherence tomography (OCT) showed subfoveal fluid and intraretinal vertical schisis cavities involving the outer retina at presentation. At 2 weeks after the trauma, the eye showed foveal atrophy. [1] I wish to discuss a few facts regarding this case...

Purpose: To compare macular thickness in children with functional amblyopia and those without amblyopia using optical coherence tomography (OCT).Methods: This case‑control study was conducted on 93 children aged 3–10 years including 44 cases with unilateral amblyopia and 49 subjects without amblyopia. Amblyopic eyes were considered as the case group and their fellow eyes as internal controls; eyes of non‑amblyopic children served as the external control.macular thickness of all eyes were measured by optical coherence tomography in the center (foveola), 1 mm ring (fovea), and 3 and 6 mm rings and compared.Results: Although macular thickness was generally not different between the study groups, there was a significant difference in central macular thickness between eyes with moderate to severe amblyopia and the external controls (P=0.037). Foveal thickness difference exceeding 10 microns between fellow eyes was detected in a larger number of amblyopic children as compared to non‑amblyopic controls (P=0.002). Mean foveal thickness was greater in boys (P=0.037) but there was no significant difference in foveal thickness among various types of refractive errors.Conclusion: Although there was no significant relationship between macular thickness and amblyopia, foveolar thickness in eyes with moderate to severe amblyopia was significantly greater than the external controls. Further studies with more cases of moderate to severe amblyopia are recommended.

Purpose: To report a case of butterfly-shaped macular dystrophy.Patient and Findings: A 34-year-old woman presented with metamorphopsia in both eyes from 2 years ago. Visual acuity was 9/10 in right eye and 10/10 in left eye. There was no pathologic finding on slit lamp biomicroscopy and funduscopy other than mild macular retinal pigment epithelium mottling. Visual fields and electroretinogram were normal but electrooculogram showed sub-normal results. Fluoresce in angiography showed black, non-fluorescent butterfly-shaped macular structures.Conclusion: Butterfly-shaped macular dystrophy occurs in middle aged subjects and presents with mild visual loss and metamorphopsia. It is slowly progressive and leads to marked visual acuity reduction in older ages. Considering the paucity of clinical findings, fluoresce in angiography and/or electrophysiological tests are recommended for making a correct diagnosis.