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A patient is referred to you by an outside ophthalmologist.  The patient recently underwent a successful cataract surgery to remove a dense white cataract.  Unfortunately, two months after surgery, the patient’s best refracted visual acuity is still 20/400 despite a totally normal examination of the anterior segment.  The outside ophthalmologist wants your opinion on what is limiting the patient’s vision. On exam, you see the above and order a OCT.

Which of the following most likely explains the patient’s limited visual acuity?

c -- macular hole  Unfortunately, this patient’s vision is limited by a stage IV macular hole.  The duration of this hole is likely unknown since the patient previously had a white cataract.  The OCT does not demonstrate any retinal thickening and does demonstrate the large macular hole.