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Etlik City Hospital, Ophtalmology, Ankara, Türkiye DOI : 10.37845/ret.vit.2026.35.11 We report the case of a 64-year-old male who developed a full-thickness macular hole (FTMH) following rhegmatogenous retinal detachment (RRD) surgery, with the foveal crack sign (FCS) detected as a preceding structural alteration on optical coherence tomography (OCT). The patient initially underwent pars plana vitrectomy with C3F8 tamponade for RRD associated with a superonasal horseshoe retinal tear, achieving successful reattachment and visual improvement. At six months postoperatively, OCT revealed a vertical hyperreflective line at the foveal center, consistent with FCS, while best-corrected visual acuity (BCVA) was 0.4. By twelve months, BCVA had declined to 0.1, and OCT demonstrated the development of an FTMH. A second vitreoretinal surgery with internal limiting membrane peeling and gas tamponade resulted in successful closure of the macular hole and visual recovery to 0.4. This case highlights the clinical significance of FCS as an early OCT biomarker that may precede macular hole formation after RRD repair. Careful postoperative OCT monitoring in patients with FCS may enable the timely recognition of high-risk eyes and facilitate earlier surgical intervention to improve visual prognosis. Keywords : Foveal crack sign; Macular hole; Rhegmatogenous retinal detachment; Optical coherence tomography; Vitrectomy