Traumatic Macular Hole: A Case Series

Purpose: To report a case series of traumatic macular hole.

Case presentations: Case A was a 64-year-old male patient with prior blunt injury in the left eye. One month after trauma, his best corrected visual acuity (BCVA) was 0.05. Spectral-domain optical coherence tomography (SD-OCT) showed full-thickness macular hole (FTMH) with a narrowest diameter of 125 μm. The patient was treated by par plana vitrectomy in 23 gauge, lower semi-circular internal limiting membrane (ILM) peeling near lower part of FTMH, FTMH covered by upper semi-circular inverted flap of ILM, and C3F8 15% flushing. At the last follow-up, His BCVA improved to 0.1. The FTMH closed with foveal ellipsoid zone disruption. Case B was a 41-year-old male patient. His initial BCVA was counting finger. The FTMH presented after trauma with narrowest hole diameter of approximately 62.5 μm. After one-month follow-up, his BCVA increased to 0.1. Spontaneous closure of traumatic macular hole was found. Case C was a 10-year-old boy with right ocular blunt injury. The initial BCVA was light perception. The anterior segment examination showed total hyphema. After hyphema resolved, a FTMH was discovered. The parents of the child refused operational treatment and lost follow-up. Case D was a 32-year-old male patient with right ocular blunt injury and subsequent full-thickness scleral laceration with uvea incarceration. The initial BCVA was counting finger. Repair of the sclera laceration was performed. After the operation, a FTMH was discovered. But the patient refused the further intervention. The FTMH persisted and enlarged.

Conclusion: Variable ages, etiologies, morphologies on SD-OCT, and clinical outcomes were observed in our case series of traumatic FTMH. Spontaneous closure or persistent opening of traumatic FTMH may occur. Small-gauge vitrectomy combined with ILM semi-circular inverted flap technique was useful to facilitate closure of traumatic macular hole.

Keywords: trauma; full-thickness macular hole; vitrectomy; internal limiting membrane peeling.