Traumatic Macular Hole: Diagnosis, Natural History, and Management

Budoff, Greg; Bhagat, Neelakshi; Zarbin, Marco A.

doi:10.1155/2019/5837832

Cited by 34 publications

(30 citation statements)

References 39 publications

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“…Several macular pathologies have been reported that may develop secondary MH such as cystoid macular edema, subretinal fluid due to rhegmatogenous retinal detachment, and SMH [2][3][4][5][6][7][8][9][10]. In most of the secondary MH associated with SMH, the SMH was caused by rupture of a retinal arterial macroaneurysm (RAM) [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…Formation of an idiopathic MH has been attributed to mechanical forces exerting tangential traction at the vitreomacular interface. Secondary MH may develop in association with trauma [2], macular edema [3], retinal detachment [4], choroidal neovascularization [5][6][7], or submacular hemorrhage (SMH) [8][9][10]. Spontaneous closure is a rare event [7,[10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Development and spontaneous closure of a secondary macular hole associated with submacular hemorrhage due to polypoidal choroidal vasculopathy: a case report

et al. 2020

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Background: Macular hole (MH) is a retinal break in the fovea involving partial or complete dehiscence of the neural retinal layers affecting the visual quality by decreasing visual acuity (VA) and visual deformation. We describe a case of secondary MH associated with submacular hemorrhage (SMH) due to polypoidal choroidal vasculopathy (PCV), which showed spontaneous closure. Case presentation: A 67-year-old man developed decreased VA in his right eye due to an SMH. The VA was 20/50, and monthly intravitreal injection of aflibercept was administered three times. The SMH gradually decreased, and 10 months later the external limiting membrane was found to be perforated, resulting in MH. The old clot disappeared, and the MH remained for 10 months. Twenty-three months later, serous retinal detachment (SRD) involving the macula appeared and the MH had disappeared. SRD gradually disappeared, and macular configuration recovered. VA gradually improved and became 20/20 38 months later. Conclusion: Dynamic change of the ultrastructure in an unusual case of secondary-developed and spontaneously closed MH was clearly observed. Although the mechanism was unknown, the small diameter size and exudative PCV are thought to have contributed to the closure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development and spontaneous closure of a secondary macular hole associated with submacular hemorrhage due to polypoidal choroidal vasculopathy: a case report

et al. 2020

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“…Many studies reported uncertain mechanism of TMH [ 3 , 7 , 9 ] with many hypotheses and speculations been put forward. The early-onset TMH is thought to be as a result of anteroposterior compression caused by blunt trauma, followed by a rebound contrecoup resulting in vitreofoveal traction [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of TMH is 1.4% in closed-globe trauma and 0.15% in open-globe injuries [ 2 ]. Due to its rarity, studies on TMH are limited [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Traumatic Macular Hole: Clinical Management and Optical Coherence Tomography Features

Lei

Chen

2020

Journal of Ophthalmology

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The complex and uncertain prognosis of traumatic macular hole (TMH) makes it a difficult and challenging problem in clinical management. The features of spontaneously closed TMH and the time of vitrectomy remain unclear. This retrospective study aimed to demonstrate the optical coherence tomography (OCT) features of TMH, explore the relationship between OCT parameters and visual outcomes, and further evaluate the therapeutic effect of surgical management. Seventeen TMH patients were included in this study. 13 eyes of TMH received vitrectomy surgery and 4 eyes of TMH were closed spontaneously. Baseline patient characteristics, surgical details, and 6-month postoperative follow-up clinical assessment were recorded prospectively. There was a moderate rate (4/17 eyes, 23.5%) of spontaneous closure. The mean time of hole closure was 9.5 ± 9.9 weeks, and 75% occurred within three months. In the spontaneously closed TMH eyes (n = 4), an intact ellipsoid band was observed in all four patients with a mean age of 12.0 ± 1.6 years and a smaller preoperative basal diameter of 418.0 ± 283.6 μm. Small basal diameter of the macular hole at baseline ( p = 0.02) was associated with spontaneous closure of TMH acuity. In the vitrectomy surgery group (n = 13), an intact ellipsoid band was observed in four patients (4/13) with a mean age of 27.0 ± 12.7 years and a larger preoperative basal diameter of 943.0 ± 444.2 μm ( p = 0.02). Vitrectomy results in a better closure rate (11/13 eyes, 84.6%). Combined with the spontaneously closed TMH eyes, the overall hole closure rate was 88.2% (15/17 eyes). After 6-month treatment for all patients, the best-corrected visual acuity (BCVA) increased to 0.59 ± 0.40 (logMAR) compared to baseline 1.01 ± 0.50 (logMAR) ( p < 0.001). The ellipsoid band integrity was found to be closely correlated with visual acuity ( p = 0.03). In conclusion, vitrectomy is an effective treatment for TMH. Surgical management for TMH achieved better anatomical closure and improved visual outcomes. Observation for 3 months may be considered before deciding if surgical intervention is suitable.

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“…[7,12] Other potential causes of TMHs include laser injury, surgical trauma, lightning strikes, and electrical shock. [13] TMHs can result in severe central visual field loss. [7,13] Other ocular pathologies may develop concurrently with TMH, such as commotio retinae, hyphema, vitreous or subretinal hemorrhage, retinal detachment, uveal tears, and choroidal rupture.…”

Section: Traumatic Mhs (Tmhs)mentioning

confidence: 99%

Secondary macular holes – A review of current management strategies

Sela¹,

Hadayer²,

Zahavi³

2020

cleverjournal

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Secondary macular holes (MHs), most commonly caused by ocular trauma and high myopia, often pose a therapeutic challenge. The development of modern imaging modalities as well as advanced surgical techniques enables a better pre-operative evaluation, diverse treatments, and improved prognosis. This review presents and discusses the treatment options for each of these conditions, to provide the necessary up to date knowledge for decision-making in these cases.

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Traumatic Macular Hole: Diagnosis, Natural History, and Management

Cited by 34 publications

References 39 publications

Development and spontaneous closure of a secondary macular hole associated with submacular hemorrhage due to polypoidal choroidal vasculopathy: a case report

Development and spontaneous closure of a secondary macular hole associated with submacular hemorrhage due to polypoidal choroidal vasculopathy: a case report

Traumatic Macular Hole: Clinical Management and Optical Coherence Tomography Features

Secondary macular holes – A review of current management strategies

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