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Vivek Chaturvedi, Ruchita R. Doshi, Joseph M. Civantos; Retrospective Review of Full Thickness Traumatic Macular Holes. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5615.
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To describe the clinical characteristics, optical coherence tomography findings, and outcome of patients who developed macular holes secondary to trauma.
Retrospective review of a consecutive series of 15 eyes of 15 patients who developed traumatic macular hole. The clinical records of all 15 eyes were reviewed, together with observation outcomes, surgery outcomes, and optical coherence tomoraphy results.
From January 2005 through November 2010, 15 eyes of 15 consecutive patients developed traumatic macular holes. The mean follow up was 33.2 months (range, 1-146 months). The mean age was 20.3 years (range, 12-47 years). Twelve (80%) patients were male. The most common type of injury was blunt trauma associated with sports activity (6 eyes, 40%). All eyes had a full thickness macular hole with no clinical evidence of a posterior vitreous detachment (stage 3 holes). The mean initial best corrected visual acuity (BCVA) was 20/400 (range, 20/70 to 3/200). Five of the 15 eyes (33%) spontaneously closed without intervention. The mean time from injury to spontenous closure was 4.2 weeks (range 2 - 8 weeks). Three of the 15 eyes (20%) did not spontaneously close with observation and did not undergo surgical intervention. Seven of the 15 eyes (46.7%) underwent pars plana vitrectomy, internal limiting membrane peeling and gas tamponade. Six of the 7 eyes (85.7%) that underwent vitrectomy successfully had their macular holes closed. Overall, 11 eyes closed (73.3%) either with observation or surgery. 80% (4/5) of the eyes that spontaneously closed had a BCVA of 20/80 or better at last follow up visit and 57% (4/7) of the eyes that underwent vitrectomy had a BCVA of 20/80 or better at last follow up visit. 13 of the 15 eyes underwent optical coherence tomography imaging at initial presentation. All 13 of these eyes confirmed a full thickness macular hole. 4 eyes had an irregular minimally reflective spaces beneath the fovea.
The sponteneous closure of traumatic macular holes is not uncommon. If the hole does not close after an initial observation period, surgical intervention can also promote closure. Optical coherence tomography reveals a wide spectrum of presentation of traumatic macular holes. Further investigation into the traumatic macular hole configuration and prognosis will be helpful.
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