Abstract
Traumatic macular hole (TMH) is not a rare clinical condition, especially in young population. Its prognosis is of complexity and uncertainty, with a relatively high rate of spontaneous closure in some cases. Modern vitrectomy surgery plays an important role in the treatment of TMH, although the functional outcomes may be compromised by the concomitant retinal pathologies. Decision-making about the time of vitrectomy, especially in pediatric patients, remains to be clarified further.
Highlights
Macular hole is a full-thickness defect of neuroretina in the foveal center, which can cause significant central vision loss
Traumatic macular hole (TMH) occurs in 1.4% among closed globe injury cases and to a less extent (0.15%) among open globe injury cases [2], it may sometimes lead to permanent significant vision loss, due to being usually associated with other retinal pathologies, including commotio retinae, diffuse retinal edema, retinal hemorrhage, vitreous hemorrhage, choroidal rupture, photoreceptor and retinal pigment epithelial (RPE) damage, and retinal tears and dialysis
This may be due to the associated damage to the RPE or photoreceptors by the trauma. They found that all cases of TMH showed no posterior vitreous detachment (PVD) and/or opercula by examination and Optical coherence tomography (OCT) [3]. This is consistent with previous studies that found relatively low rates of PVD in TMH patients [5, 6], which is in opposition to the theory of Yokotsuka et al that the sudden vitreous separation is the cause of TMH [4]
Summary
Macular hole is a full-thickness defect of neuroretina in the foveal center, which can cause significant central vision loss. The most common type of macular hole is idiopathic macular holes (IMH), which is caused by the both anteroposterior and tangential vitreous traction on the foveal center [1]. Traumatic macular hole (TMH) is the second most common cause of macular hole. TMH occurs in 1.4% among closed globe injury cases and to a less extent (0.15%) among open globe injury cases [2], it may sometimes lead to permanent significant vision loss, due to being usually associated with other retinal pathologies, including commotio retinae, diffuse retinal edema, retinal hemorrhage, vitreous hemorrhage, choroidal rupture, photoreceptor and RPE damage, and retinal tears and dialysis. In a retrospective comparison study with IMH, Huang et al found that TMH patients were younger (27.11 versus 61.98 y), mainly male (86.3% versus 27.7%), and with worse vision (LogMar VA 1.23 versus 1.06) [3]
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