Original article
Spontaneous closure of traumatic macular hole

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Abstract

PURPOSE : To report eight cases of spontaneous closure of traumatic macular hole.

DESIGN : Consecutive observational case series.

PATIENTS AND METHODS : In a consecutive series of 18 eyes of 18 patients with traumatic macular hole, eight patients achieved spontaneous closure of traumatic macular hole. Clinical records of the eight eyes of eight patients were reviewed, together with the results of optical coherence tomography performed in three eyes.

RESULTS : All eight patients with spontaneous closure of traumatic macular hole were males, with a mean age of 14.6 years (range, 11–21 years). The major cause of blunt trauma was sports-related accidents. Six eyes developed visual symptoms immediately after trauma and two eyes 10 to 12 days later. In all eight eyes, contact lens biomicroscopy revealed a small, full-thickness macular hole not complicated by epiretinal membrane, cuff of subretinal fluid, or posterior vitreous detachment. The macular hole closed spontaneously 1 week to 4 months after trauma. All eight eyes had visual acuity improvement with the final best-corrected visual acuity of 0.5 or better in four (50%) eyes. Optical coherence tomography in three eyes revealed two distinct abnormalities. Two eyes presented with acute foveal dehiscence without involvement of the posterior vitreous cortex. The remaining eye showed at presentation perifoveal vitreous detachment with residual vitreous adhesion to the edge of updrawn fovea and developed release of the vitreofoveal adhesion at the time of hole closure.

CONCLUSIONS : Spontaneous closure of traumatic macular hole is not uncommon. An observation for a period of up to four months may be a management of choice for traumatic macular hole. There may be clinically and pathogenetically two distinct mechanisms of traumatic macular formation; one type that causes immediate visual loss due to primary dehiscence of the fovea, and the other type that leads to delayed visual loss due to dehiscence of the fovea secondary to persistent vitreofoveal adhesion.

Section snippets

Patients and methods

We reviewed clinical records of a consecutive series of 18 eyes of 18 patients with traumatic macular hole who were referred to us between 1986 and 2000. They were first examined on the following day or within 2 weeks after trauma and observed without surgery for a mean follow-up time of 8.4 months (range, 4–12 months). Routine examination included history taking for causes of injury and onset of visual symptoms, recording of best-corrected visual acuity, refraction, contact lens biomicroscopy,

Results

In a consecutive series of 18 eyes of 18 patients with traumatic macular hole, eight (44%) eyes showed a spontaneous hole closure. Table 1 summarizes the clinical characteristics of the eight eyes of spontaneous macular hole closure. All eight patients were males with a mean age of 14.6 years (range, 11 to 21 years). The major cause of injury was sports-related accidents including contusion by soccer ball and baseball. As regards the onset of visual symptoms, six patients had immediate visual

Case 1

A 13-year-old boy had his right eye accidentally hit by a vinyl slipper and immediate visual loss. He was referred to us on the following day. Best-corrected visual acuity of the affected eye was 0.02. Contact lens biomicroscopy revealed commotio retinae in the posterior pole and a small macular hole not complicated by cuff of subretinal fluid, epiretinal membrane, or posterior vitreous detachment (Figure 1A). Optical coherence tomography showed a full-thickness macular hole with a thickened

Discussion

In our series of 18 eyes of traumatic macular hole, eight (44%) showed spontaneous hole closure at a mean follow-up of 8.4 months. Mizusawa and associates5 reported that one (10%) of ten eyes achieved spontaneous hole closure at a follow-up of 8 months or longer, and Tomii and associates6 reported that four (67%) of six eyes had spontaneous hole closure during a follow-up of 3 months or longer. Thus, spontaneous closure of traumatic macular hole is obviously not uncommon, but its general

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