Traumatic Macular Holes: A Comparison of Surgical Repair to Natural History

Abstract

Abstract: : Purpose: To compare the outcome of surgical intervention to observation for traumatic macular hole. Methods: We reviewed medical records and photographs of eight patients with traumatic macular holes for which no vitreous surgery was performed (natural history group) and 12 patients with traumatic macular hole who underwent vitreous surgery with internal tamponade (surgical group). Preoperative and postoperative vision as well as macular hole size and configuration (elevated-open, flat-open or flat-closed) were compared between the two groups. Vision of hand motion and light perception were assigned the Snellen equivalent of 20/4000 and 20/8000, respectively. Results: Natural history group: This group was comprised of 6 men and 2 women. Mechanism of injury was known in seven patients. Average age at the time of trauma was 22 years (range 6-38 years). The average macular hole size was 525µm. The pre-trauma visual acuity was unavailable but reported as normal by all patients in both groups. The initial visual acuity was 20/1500 (range 20/200-hand motions). Average length of follow up was 11.5 years (range 9 months-48 years). At final follow-up macular hole configuration was elevated-open in five patients, flat-open in two patients and flat-closed in one patient. Visual improvement was observed in the one patient (13%) with spontaneous hole closure (flat-closed). Surgical group: This group was comprised of 10 men and 2 women. The mechanism of injury was known in all patients. Average macular hole size was 615µm. The initial visual acuity was 20/1600 (range 20/50-light perception). Average follow-up was 12 months (range 1.5-48 months). At final follow-up, the macular hole configuration was flat-closed in six (50%) patients, flat-open in four patients and remained elevated-open in two patients. Ten (83%) of 12 eyes had visual improvement. Conclusions: Surgical intervention for traumatic macular hole offers a greater chance for visual improvement. Visual acuity is often limited by associated eye trauma. Flattening of the subretinal fluid cuff, regardless of macular hole closure, appears important in maintaining visual improvement.

Keywords: macular holes • trauma • vitreoretinal surgery