Traumatic Macular Hole Research Articles

Efficacy of different vitreous tamponade for the treatment of traumatic macular holes

Objective To compare the efficacy of different vitreous tamponade for the treatment of traumatic macular holes. Methods The clinical data of 68 eyes of 68 patients with traumatic macular hole were collected and analized retrospectively.All cases underwent vitrectomy, during surgery tamponaded with air in 25 patients, 14% C3F8 gas in 28 patients and silicone oil in 15 patients respectively.The closure rate of macular hole, visual acuity and complications were analyzed after surgery. Results The macular hole closure rates in air group and C3F8 group were higher than those in silicone oil group(P=0.01, 0.03), and the difference of macular hole closure rates were not statistically significant between air group and C3F8 group (P=0.19). The rate of visual acuity improvement in air group and C3F8 group were higher than that in silicone oil group(P=0.00, 0.00), and the difference was not statistically significant between air group and C3F8 group(P=0.59). The incidence of complicated cataract in silicon oil group was higher than that of other two groups(P=0.00, 0.00). Conclusion Vitrectomy combined with air tamponade for traumatic macular hole is effective in closure rate and vision improvement.The efficacy is similar with 14% C3F8 tamponade.Silicone oil may be selected in some especial or complicated cases. Key words: Vitrectomy; Silicone oil; Air; Noble gas; Macular hole, traumatic

Optical Coherence Tomography Imaging After Surgical Closure of Pediatric Traumatic Macular Holes

Purpose: To date, little attention has been directed to retinal photoreceptor migration after traumatic macular hole surgical repair in the pediatric population. The purpose of this study was to evaluate optical coherence tomography (OCT) findings in the foveae of pediatric patients with history of traumatic macular hole surgical repair. Methods: Retrospective case series of 3 eyes in 3 pediatric patients with traumatic macular hole surgical repair. Spectral domain OCT images were obtained pre- and postoperatively. Results: We report 3 cases of restoration of the ellipsoid zone with good visual acuity outcomes following macular hole closure. Conclusion: Optical coherence tomography findings of an intact ellipsoid zone may be a predictor of visual acuity and explain better surgical outcomes in the pediatric population.

Excellent visual outcome after vitrectomy for traumatic macular hole associated with choroidal rupture across papillomacular bundle.

PURPOSE:To report the visual result of Surgery for traumatic macular hole with choroidal rupture running across papillomacular bundle.METHOD:Observation case report Patient 20 year old male patient presented with acute vison loss in OS with BCVA reduced to 20/80 following blunt trauma. Examination revealed full thickness macular hole with choroidal rupture between disc and macula, spanning across papillomacular bundle (PMB) in OS. Patient underwent 25G Vitreous Surgery with ILM peeling and SF6 injection for OS.RESULTS:Macular hole was successfully closed at 4 weeks follow up and BCVA improved to 20/20. There was no postoperative complicationCONCLUSION:We report that Traumatic macular holes with associated choroidal rupture running through PMB can be successfully repaired with Vitreous surgery and these eyes may achieve good visual outcome.

Surgical treatment of traumatic macular hole

PurposeTo present the results of the treatment of traumatic macular holes.MethodsThis study is a retrospective consecutive case series of 7 patients who underwent a 25G PPV with the displacement of macular retina after subretinal balanced salt solution injection to treat traumatic full thickness macular holes (TFMH). The efficiency was evaluated by the anatomical macular hole closure rate and best‐corrected visual acuity (BCVA) during follow‐up visits. The degree of retinal displacement was accessed by comparing the preoperative and postoperative fundus photographies.ResultsComplete closure of macular hole was achieved in 85,7% and 14,3% had partial closure. Average macular hole diameter was (825 μm). Visual acuity after surgery in the total group was significantly increased. All patients revealed a negative correlation between postoperative visual acuity and the time elapsed from the moment of the trauma, and a strong positive correlation between the macular hole size and elapsed time from the injury. There were no intraoperative or postoperative complications.ConclusionVitrectomy with the «retinal displacement» technique may be an effective addition to surgical options for treating traumatic macular holes.

Spontaneous closure of traumatic macular hole in a pediatric patient

We present the case of a 14-year-old boy with ocular trauma and the complete eye-tracking OCT imaging follow-up of thedevelopment and later spontaneous closure of a secondarymacular hole.

Inverted ILM Flap Technique in a Pediatric Traumatic Macular Hole—A Case Report

Purpose: To report and describe the clinical course of a pediatric traumatic macular hole (TMH) case and its management. Case Report: A pediatric patient presented a macular hole following blunt ocular trauma. The patient was followed every 2 weeks for 4 months. After the worsening of the macular hole reported by optical coherence tomography (OCT), pars plana vitrectomy with inverted flap technique plus SF6 gas tamponade was performed. Traumatic macular hole appeared closed at the OCT during follow-up. Initial visual acuity was counting finger at 30 cm. After surgery, the patient achieved a visual acuity of 20/100 at 3-month follow-up. Conclusion: This case shows a good anatomic and functional success performing a pars plana vitrectomy with inverted flap technique in a large TMH in a pediatric patient. We underline the importance of the surgical timing in the management of similar cases.

Comparison on clinical efficacy of surgical treatment and conservative treatment for traumatic macular hole

Objective To compare the clinical efficacy of surgical and conservative therapy in patients with traumatic macular hole. Methods The data of 56 eyes of 56 cases with traumatic macular hole were retrospectively analysed. Thirty cases were rondomly selected as surgical group, and treated with vitrectomy, internal limiting membrane peeling and C3F8 gas tamponade. Twenty-six cases of the same period were used as control group, and treated with conservative therapy. The visual acuity and macular hole diameter after treatment between the two groups were compared and analyzed. Results All patients were followed up for 3-6 months, average (4.6±0.5). The hole closed in 26 cases (86.7%), visual acuity improved in 15 cases (50%) at the last follow-up time in surgical group. The control group were 11 cases (39.3%) and 12 cases (46.2%) accordingly. The closure rate of macular hole in the surgical group was better than that of the conservative group (χ2=10.327, P=0.001), but there was no significant difference in visual acuity between two groups. Conclusion Surgical treatment is helpful to improve the closure rate of traumatic macular hole, but the improvement of visual acuity is not obvious. Key words: Macular hole, traumatic; Surgery; Drug therapy; Visual acuity

Current Management of Traumatic Macular Holes.

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.

Management Modalities for Traumatic Macular Hole: A Systematic Review and Single-Arm Meta-Analysis

ABSTRACTPurposes: The purposes of this study were to (i) determine macular hole (MH) closure rates and visual outcomes by comparing two methods of managing traumatic MH (TMH)—an event resulting in severe loss of visual acuity (VA); (ii) characterize patients who undergo spontaneous TMH closure; (iii) determine which TMH patients should be observed before resorting to surgical repair; and (iv) elucidate factors that influence postoperative visual outcomes.Methods: Studies (n=10) of patients who were managed by surgery or observation for TMH were meta-analyzed retrospectively. Management modalities included surgical repair (surgery group) and observation for spontaneous hole closure (observation group). In addition, a 12-case series of articles (1990–2014) on spontaneous hole closure was statistically summarized. SAS and Comprehensive Meta-Analysis (CMA) (version 3.0) were used for analysis.Results: For surgery group patients, the fixed-model pooled event rate for hole closure was 0.919 (range, 0.861–0.954) and for observation group patients, 0.368 (range, 0.236–0.448). The random-model pooled event rate for improvement of visual acuity (VA) for surgery group patients was 0.748 (range, 0.610–0.849) and for observation group patients, 0.505 (range, 0.397–0.613). For patients in both groups, the mean age of spontaneous closure was 18.71±10.64 years; mean size of TMHs, 0.18±0.06 decimal degrees (DD); and mean time for hole closure, 3.38±3.08 months. The pooled event rate for visual improvement was 0.748 (0.610–0.849).Conclusions: Hole closure and VA improvement rates of surgery group patients were significantly higher than those for observation group patients. Patients of ≤ 24 years of age with MH sizes of ≤ 0.2DD were more likely to achieve spontaneous hole closure. The interval of time from injury to surgery was statistically significantly associated with the level of visual improvement.

Induction of Posterior Vitreous Detachment in Pediatric Vitrectomy by Preoperative Intravitreal Injection of Tissue Plasminogen Activator.

To report the efficacy of intravitreal injection of tissue plasminogen activator (tPA) with or without autoserum in induction of posterior vitreous detachment (PVD) in pediatric vitrectomy. Retrospective, interventional case series of pediatric patients receiving intravitreal injection of tPA preoperatively to facilitate PVD in vitrectomy from January 2011 to December 2014 at the Changhua Christian Hospital, Taiwan. All patients received intravitreal injections of 25 µg of tPA 3 days before vitrectomy. For cases without preexisting vitreous hemorrhage, 0.1 mL of intravitreal autologous serum was co-administered. Main outcome measures included successful rate of posterior vitreous detachment in vitrectomy, visual outcome, and related ocular complications. Four boys and 2 girls were included. Ages ranged from 39 weeks' postmenstrual age to 8 years. The indications for vitrectomy were traumatic macular hole (cases 1 and 2); premacular hemorrhage secondary to retinopathy of prematurity (case 3); abusive head trauma with premacular hemorrhage, subinternal limiting membrane hemorrhage, and macular hole (case 4); trauma with dense vitreous hemorrhage (case 5); and vitreous hemorrhage with unknown cause (case 6). Successful PVD was induced intraoperatively in all cases and the macular hole was closed successfully in 3 of 3 cases (cases 1, 2, and 4). No surgical complications were noted. Visual outcome improved in all 3 eyes with checkable preoperative visual acuity (cases 1, 2, and 6). Intravitreal injection of tPA 3 days before vitrectomy may be a helpful adjunct to induce pediatric PVD.

Inverted Internal Limiting Membrane Flap For Large Traumatic Macular Holes

The aim of the study was to assess the role of inverted internal limiting membrane flap as a treatment option for large traumatic macular holes.This is a prospective noncomparative study in which 12 eyes with large traumatic macular holes (basal diameter of 1300-2800 μm) since 3 to 6 months were subjected to standard 23-gauge vitrectomy with removal of the posterior hyaloid, brilliant blue G (BBG)-assisted internal limiting membrane peeling in a circular fashion keeping it attached to the edge of the hole to create a flap. At the end of the surgery, air fluid exchange was done with inversion of the internal limiting membrane flap inside the macular hole using the soft tipped cannula and sulfur hexafluoride 20% as tamponade. The main follow-up measures are the best corrected visual acuity and the optical coherence tomography for 6 to 9 months.All the included eyes had a closed hole from the first week postoperative and along the follow-up period (6-9 months). The best corrected visual acuity improved from 20/2000 to 20/200 with a median of 20/400 preoperatively to 20/400 to 20/50 with a median of 20/100 at the end of follow-up period.Inverted internal limiting membrane flap is a good adjuvant to standard vitrectomy in the management of large traumatic macular holes that led to the 100% closure rate and improvement of best corrected visual acuity.

Traumatic Macular Hole Repair Following Surgery for Subretinal Hemorrhage

Traumatic Macular Hole Repair Following Surgery for Subretinal Hemorrhage

Long-term Follow-up and Outcomes in Traumatic Macular Holes

To review presenting characteristics, clinical course, and long-term visual and anatomic outcomes of patients with traumatic macular holes at a tertiary referral center. Retrospective case series. Twenty-eight consecutive patients with traumatic macular holes at a single tertiary referral center were reviewed. In addition to visual acuities and treatments throughout the clinical course, specific dimensions of the macular hole, including diameters, height, configuration, shape, and the presence of a cuff of fluid, were examined using spectral-domain optical coherence tomography (OCT). Twenty-eight patients were identified with a mean initial visual acuity (VA) of logMAR 1.3 (20/400) and a mean follow-up of 2.2 years. Eleven holes (39.3%) closed spontaneously in median 5.7weeks. Eleven underwent vitrectomy with a median time to intervention of 35.1weeks. Median time to surgery for the 5 eyes with successful hole closure was 11.0weeks vs 56.3weeks for the 6 eyes that failed to close (P= .02). VA improved in closed holes (P < .01), whether spontaneously (P < .01) or via vitrectomy (P= .04), but VA did not improve in holes that did not close (P= .22). There was no relation between initial OCT dimensions and final hole closure status, although there was a trend, which did not reach statistical significance, toward small dimensions for those that closed spontaneously. A fairly high spontaneous closure rate was observed, with a trend toward smaller OCT dimensions. We found no relationship between hole closure and the OCT characteristics of the hole. Surgical intervention was less successful at hole closure when elected after 3months.

Prediction of spontaneous closure of traumatic macular hole with spectral domain optical coherence tomography.

It has been known that some traumatic macular holes can close spontaneously. However, knowledge about the types of macular hole that can close spontaneously is limited. In this retrospective study, we investigated patients with traumatic macular hole who were followed-up for at least 6 months without any surgical intervention. Clinical data and spectral domain optical coherence tomography (SD-OCT) images were compared between groups with and without macular hole closure. Overall, 27 eyes were included. Spontaneous closure of macular hole was observed in 10 (37.0%) eyes. The holes with spontaneous closure had smaller minimum diameter (244.9 ± 114.4 vs. 523.9 ± 320.0 μm, p = 0.007) and less intraretinal cysts (10% vs. 76.5%, p = 0.001) compared to the holes that did not close spontaneously. The area under the curve of receiver operative characteristic was 0.812 and 0.832 for minimum diameter of macular hole and presence of intraretinal cysts respectively. Multivariate logistic regression showed that the presence of intraretinal cysts was an independent predictive factor for closure of macular holes. The group with spontaneous macular hole closure had a high chance of visual improvement. Our study suggests that the absence of intraretinal cysts on SD-OCT can predict spontaneous closure of traumatic macular hole.

The analysis on the efficacy of conservative treatment for traumatic macular hole in young persons

Objective To analyse the efficacy of conservative treatment for traumatic macular hole in young persons. Methods Thirty-four eys of 34 young patients of traumatic macular hole from 2011 to 2013 were collected in this study. After confirming the diagnosis, the conservative treatment was given to all of them, and they would be reviewed on the first day, the third day, the first week and following every week. The healing station of traumatic macular hole was observed. Results Among the 34 cases, the macular hole healed in 5 eyes within 1 week, healed in 15 eyes on the second week, healed in 6 eyes within 1 month, healed in 4 eyes after nearly 2 months, and healed in only 1 eye on the third month. The vision of them were all improved to different extent. The macular hole did not heal in 3 eyes after 3 months, and retinal detachment of small scale occurred in 2 eyes. Conclusion For the special group of young persons, conservative treatment should be the first choice for traumatic macular hole. Key words: Macular hole, traumatic, adolescent; Treatment, conservative

The vitreoretinal surgery for traumatic macular hole retinal detachment

Objective To observe the clinical effect and visual function of vitrectomy combined with internal limiting membrane peeling for traumatic macular hole retinal detachment. Methods The clinical data of 30 eyes of 30 patients with traumatic macular hole retinal detachment who had undergone vitrectomy combined with internal limiting membrane peeling were analyzed retrospectively. The visual acuity and changes of macular area optical coherence tomonraphy (OCT) and multifocal electroretinogram (mfERG) in pre-operation and post-operation were observed.The follow-up time was 12 months. Results The retinal reattachment rate after surgery was 80.00%. Most of the patients achieved a better final visual acuity.Mf-ERG showed the response densities of ring 2, ring 3, and ring 4 areas of N1 wave and ring 2, ring 3, ring 4 and ring 5 areas of P1 wave in postoperative group were significantly increased while the latencies of ring 4 of N1 wave and the latencies of ring 3, ring 4 and ring 5 of P1 wave were significantly different with that of preoperative group (P<0.05). Conclusion Vitrectomy combined with internal limiting membrane peeling for traumatic macular hole retinal detachment is effective with fewer complications and can significantly improve visual function. Key words: Retinal detachment, macular hole, traumatic; Vitrectomy; Peeling, internal limiting membrane

A Mechanism for Spontaneous Closure of a Traumatic Macular Hole with Commotio Retinae in a Pediatric Patient

Macular holes can arise from different etiologies and can lead to vision loss. Though various treatments have been proposed, the management of ＂traumatic＂ macular holes is not widely standardized. We report on a case of a ＂traumatic＂ macular hole in a pediatric patient that spontaneously closed through a distinct mechanism, that we characterized by ocular coherence tomography. Over 6 months, the patient's visual acuity improved from 20/400 to 20/40 as the macular hole closed.

Clinical analysis of 47 cases with traumatic macular hole resulted from ocular contusion

Objective To analyze the clinical characteristic, treatment and prognosis of traumatic macular holes resulted from ocular contusion. Methods The clinical data of 47 cases with traumatic macular hole was retrospectively reviewed. The general condition of the patients was summarized, optical coherence tomography and multifocal electroretinogram (mfERG) were used to evaluate anatomic and functional outcomes. The patients were divided into observation group and surgery group by the treatment they received, and the prognosis was evaluated. Results Traumatic macular hole occurs mainly in male. In the observation group, the mean diameter of macular hole was(490.0±86.9) μm. During the 12 month follow-up, the holes in 7 cases (33.3%) were closed spontaneously, Vision and diameters of 14 cases (57.1%) maintained stable for a long time, the vision of 1 case (3.3%) declined mildly and the diameter of 1 case (3.3%) enlarged slightly. Visual acuity was improved significantly at last follow-up (Z= -2.40, P 0.05). The amplitudes of N1 wave in 6 cases (23.1%) improved merely and the difference was not statistically significant(t=1.98, P>0.05). These data suggests that the macular function was recovered slightly only in a few patients. Conclusions A part of the patients with smaller diameters of macular holes may close spontaneously, and they may get better visual acuity. Vitrectomy may help to close the macular holes in some severe cases, but the improvement of functional outcomes is not significant. Key words: Retinal perforations/surgery; Retinal perforations/drug therapy; Vitrectomy

Intraretinal Silicone Oil Infiltration following Traumatic Macular Hole Repair

Purpose: To present a case study describing incorporation of silicone oil into a traumatic macular hole following surgical correction. Methods: Case report Results: A nine-year-old male presented with a traumatic macular hole. After waiting for spontaneous closure, pars plana vitrectomy with standard 1000 centistroke silicone oil tamponade was performed. Postoperatively, spectral-domain optical coherence tomography, demonstrated closure of the macular hole, but with infiltration of silicone oil into the foveal architecture. A second surgical approach with different attempts to remove the retained silicone oil's bubble was successfully performed using a soft-tip cannula. However, the macular hole reopened intraoperatively. Therefore silicone oil was replaced with no infiltration and adequate closure of the macular hole. Conclusion: Previous reports have demonstrated small droplets of retained silicone oil within the retinal layers, but to our knowledge, this is the first report of a large globule of oil becoming incorporated into a healing macular hole.

Spontaneous closure of traumatic macular holes

ObjectiveTo present a series of cases with spontaneous closure of traumatic macular hole. DesignCase series. ParticipantsSix eyes of 6 patients with traumatic macular hole. MethodsThe characteristics of eyes with macular hole secondary to blunt trauma in which the macular hole closed spontaneously without surgical manipulation were reviewed. ResultsPatient age range was 13 to 55 years. There were 4 full-thickness and 2 lamellar macular holes. Spontaneous closure occurred after 1 to 6 months of observation. Best corrected visual acuity improved in 5 eyes and remained unchanged in the other eye. ConclusionsSpontaneous closure of traumatic macular holes may occur within 6 months after initial presentation.