Sir,

We describe a case of sclopetaria occurring in a young male (10-year-old) shot by a high-velocity bullet (air-pistol) passing adjacent to the eye wall at close range.

The retinal examination showed an area of injury adjacent to the path of the missile in the inferior temporal quadrant characterized by the presence of retinal and choroidal haemorrhages (Figure 1a). A second area of injury remote from the path of the missile involved the macula area and caused a traumatic macular hole (Figure 1b and c). Visual acuity was R.E.: 20/20 and L.E.: 20/40. CT scan of the head and ultrasound of the globe and orbit were performed to rule out foreign body and ruptured globe.

Figure 1
figure 1

(a) The colour fundus photograph before surgery shows retinal and choroidal haemorrhages; (b) OCT scans show the development of a full-thickness macular hole; (c) the colour fundus photograph shows a full-thickness macular hole; (d) the colour fundus photograph after surgery shows that the chorioretinal peripheral lesion healed with the development of white, fibrous scar tissue with pigment at its edges; (e and f) colour fundus photograph and OCT scans show the closure of macular hole after the vitrectomy and ILM peeling.

Full size image

As the risk of acute retinal detachment was low,1 we thought that observation was the appropriate management of this injury.

However, patient noted a progressive visual loss. The BCVA decreased to 20/100. At this stage, we decided to perform a three-port pars plana 20 gauge vitrectomy with triamcinolone-assisted peeling of the posterior hyaloid face from the posterior pole (Kenalog, Squibb-Mayers). Indocyanine green dye (0.5%) was instilled over the macula, and after removal of the ICG, the retinal internal-limiting membrane (ILM) was peeled. Gas tamponade with perfluoropropane was used and patient was asked to position himself facedown for 1–2 weeks. During the surgical procedure, a retinal break remote from the path of the missile in the superior temporal quadrant was detected and it was treated with the laser.

Sclopetaria1, 2, 3 may be a consequence of trauma by blunt object. In our case, the patient developed a progressive visual loss caused by a full-thickness macular hole. The injury is believed to result indirectly from transmission of shock waves through the wall of the eye.4 Vitreous surgery with ILM removal lead to hole closure and visual improvement (Figure 1e and f). The chorioretinal peripheral lesion healed with the development of white, fibrous scar tissue (Figure 1d).

BCVA 2 years later was 20/26. The last OCT examination confirmed the complete closure of the macular hole: the retina has regained the normal foveal contour.