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

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.