Abstract
Abstract: :
Purpose: To assess retinal and visual function in eyes with traumatic macular hole and compare the results to structural changes. Methods: Two patients (10 and 15 years old, cases 1 and 2 respectively) with traumatic macular hole (case 1–OD, case 2–OS) were studied. Visual acuity, slit lamp examination, indirect ophthalmoscopy, fundus photographs, optical coherence tomography (OCT), scanning laser ophthalmoscope microperimetry (SLO), Humphrey 10–2 visual fields, and mfERGs were performed 1–4 months post–trauma. The mfERG stimulus consisted of 103 scaled hexagons; the display subtended 50 degrees in diameter. Fixation stability was continuously monitored. First and second–order kernels were analyzed. The amplitude and implicit times of the 1st–order kernels were analyzed as described in Hood and Li (1997). Results:Best corrected visual acuity was count fingers at 3 feet (case 1) and 20/400 (case 2). Fundoscopic examination revealed no vitreal separation and a macular hole surrounded by RPE pigmentary changes extending 15 degrees in diameter. OCT measurements demonstrated 826 micron and 851 micron macular holes respectively, SLO microperimetry results showed good correspondence with areas of RPE pigmentary changes in case 2. HVF 10–2 showed sensitivity loss throughout the tested area in both cases; however the severity of loss did not correspond to the degree of structural changes seen on clinical examination. The mfERG showed decreased response amplitudes within the central 15 degrees and none detectable 2nd order kernels. The 1st order kernels were markedly decreased in the central 5 degrees. Implicit times were only slightly increased compared to the fellow eye. In both cases the decreased mf ERG responses affected an area that was more extensive than the area of RPE pigmentary changes. Conclusions: In traumatic macular holes it is important to assess both retinal function and structure as dysfunction may be more extensive than is clinically apparent. The results of these tests aid in treatment decisions.
Keywords: electroretinography: clinical • trauma • macular holes