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Manish Tandon, David Maberley, KIM RAMASAMY; Role of Intravenous Methyl Prednisolone in closure of recent post traumatic full thickness macular hole-A case series. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6390.
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© ARVO (1962-2015); The Authors (2016-present)
Current management of traumatic full thickness macular hole (TMH) secondary to closed globe injury (CGI) lacks a specific guideline as spontaneous closure is known and some surgeons advocate surgery. The aim of this study is to present a novel method in the management of TMH secondary to CGI by giving intravenous methyl prednisolone (IVMP). The hypothesis of our study is based on the fact that there occurs a breach in blood retinal barrier which is maximal in the first 72 hours and IVMP will reduce the inflammation and the reparative process will result in closure of TMH.
The institutional review board and ethical committee approval was obtained before undertaking this study.The inclusion criteria (IC) were TMH secondary to CGI with an early presentation (less than 72 hours). Patients with open globe injury, presentation after 72 hours, head injury, coma or loss of consciousness, history of previous treatment for ocular trauma, systemic diseases like diabetes and hypertension and previous signs of ocular inflammation were excluded.Patients (parents, in case of minors) fulfilling our IC were given the treatment options of conservative management, surgery and IVMP and those who voluntarily consented to participate received IVMP.We treated six patients with IVMP on four consecutive days under the supervision of an internist who monitored the patients.Serial optical coherence tomography, fundus photography, visual acuity (VA) and blood sugar evaluation were done on each subsequent day.The expected outcome was the successful anatomical closure the TMH.
Six male patients of average (avg.) age of 13 years presented within 44 hours (avg.) The presenting VA (avg.) was 1.25 Log Mar (LM).All patients had closure of TMH within 48 hours (avg). The VA at the time of discharge 0.9 LM and 0.67 LM (avg.) after three months.One patient had hyperglycaemia and was managed with insulin and has not had any other systemic or ocular side effect noted over three months.
Our results prove that our hypothesis may be correct and we can avoid surgery with a quick visual rehabilitation for a potentially surgical condition. The small sample size of the present study is a limiting factor but as more clinicians try this technique there shall be more evidence about the pros and cons of this technique in comparison to conservative management and surgery.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
TMH closure in 72 hours.
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