First Case Report of Successful Use of ILM Peeling, Inverted Flap and PRGF-Endoret® in Bilateral Macular Hole in Behçet’s Disease

To report the successful use of internal limiting membrane peeling, inverted flap and plasma rich in growth factors in bilateral full-thickness macular hole in Behçet's disease. A comprehensive multimodal ophthalmological examination, including optical coherence tomography, fluorescein angiography and indocyanine angiography, was conducted along with a multidisciplinary approach. An individualized systemic immunosuppressive treatment was initiated, and surgical treatment was planned in both eyes. A 29-year-old patient with bilateral full thickness macular hole was eventually diagnosed with Behçet's disease based on recurrent oral and genital ulcers and bilateral vitritis. Best corrected visual acuity at presentation was 20/400 in the right eye and 20/200 in the left eye. Treatment with steroids and azathioprine was initiated with an appropriate clinical response. Finally, a bilateral 25-G pars plana vitrectomy with internal limiting membrane peeling, inverted flap and application of plasma rich in growth factors (Endoret®) with C3F8 tamponade was performed. Successful bilateral closure was achieved and visual acuity improved to 20/100 in both eyes. Full thickness macular hole in young patients may be a sign of occult or uncontrolled Behçet's disease. The use of plasma rich in growth factors (Endoret®), ILM peeling and inverted flap may be a useful surgical approach in these cases.