Less commonly recognised is the spontaneous closure of such holes. Alain gaudric, ramin tadayoni, in retina fifth edition, 20. Case report open access spontaneous traumatic macular. Conversely, an impact by material larger than the orbital aperture causes a blowout fracture with the force transmitted through the orbital wall. Spontaneous closure of a traumatic macular hole is an unusual outcome. Retinal physician traumatic macular holes in the pediatric. Because of foveal involvement, macular holes can be detrimental to. When a fullthickness defect develops in the macula, the condition is referred to as macular hole. Mean range time between trauma and macular hole mh diagnosis was 8. Vitrectomy, fluidgas exchange and transforming growth factor. Pdf spontaneous closure of traumatic macular hole researchgate. Singh performs a pars plana vitrectomy, followed by internal limiting membrane ilm peeling using an internal flap technique. A traumatic, fullthickness macular hole secondary to application of a highenergy nd. Pdf longterm followup and outcomes in traumatic macular holes.
Different findings can be observed depending the stage of. Macular hole caused by blunt trauma in a 22yearold patient prior to surgery employing the inverted ilm flap technique. Fullthickness macular holes ftmh can develop as result of intraocular inflammatory disease, trauma, or vitreous detachment, among other causes. Optical coherence tomography and fundus microperimetry.
We report 2 cases of traumatic macular hole with different. Case report open access spontaneous traumatic macular hole closure in a 50yearold woman. Macular hole the macula is a small area in the center of the. May 14, 2018 a 30 yo male patient presented with a retinal detachment secondary to a macular hole. Regular clinical follow up of traumatic macular hole can sometimes avoid surgical intervention. More data will be necessary to determine whether the surgical or expectant approach is the most appropriate for traumatic macular holes in children. Spontaneous closure of pediatric traumatic macular hole. Subhyaloid hemorrhage, traumatic macular hole, and electric. American society of retina specialists the foundation. Reviewarticle current management of traumatic macular holes. Pdf macular hole formation is a wellknown complication following ocular trauma.
Find, read and cite all the research you need on researchgate. Jun 25, 2014 10 year old with traumatic macular hole that did not spontaneously resolve. Concomitant traumatic macular hole and orbital blowout. Traumatic submacular hemorrhage with macular hole repaired by. He suffered a blunt ocular trauma several years ago.
Authors suggest that, regardless of their etiology, there is an evolutionary sequence with. Cureus chronic traumatic giant macular hole repair with. Smhisapotential visually devastating condition, most commonly associated with cnv due to amd 1, 5, 6. A macular hole is a fullthickness retinal defect in the central macula, believed to be caused by vitreoretinal mechanical forces. Traumatic macular hole is a disease whose pathogenesis is not fully understood and the best treatment guideline is controversial. We report 2 cases of traumatic macular hole with different treatment approaches. Closure of traumatic macular hole tmh can be achieved spontaneously or by surgical intervention.
Mitamura y, saito w, ishida m, yamamoto s, takeuchi s. Jun 01, 2014 a macular hole is a fullthickness retinal defect in the central macula, believed to be caused by vitreoretinal mechanical forces. The hyaloid was detached from the hole and it was probably a grade 4 macular hole. Pdf spontaneous traumatic macular hole closure in a 50year. Case report open access spontaneous traumatic macular hole. In the right eye of a 10yearold child, a traumatic macular hole was observed to spontaneously resolve 18 weeks after blunt trauma. Noyes 4 1871 gave a detailed ophthalmoscopic description of a traumatic case, and ogilvie 1900 was the first to use the term hole at the macula. Surgical treatment of traumatic macular hole two case. His dilated fundus examination revealed a 3000 um basediameter full thickness macular hole. Traumatic macular holes tmh are wellknown complications of ocular contusion injury. The traumatic macular hole is a rare pathology posterior to eye injuries, resulting in loss of visual acuity. Pdf traumatic macular hole tmh is not a rare clinical condition, especially in young population.
Preoperative clinical data, surgical details, and 3month postoperative outcomes were recorded prospectively. The hyaloid was removed and the ilm was peeled after staining it with brilliant blue dye. Traumatic macular holes result from anteroposterior and tangential vitreoretinal traction and may exhibit concurrent additional pathologies such as berlins edema and subretinal fluid. A large traumatic macular hole poses a challenge to the vitreoretinal surgeon, because both characteristicslarge and traumaticare associated with lower surgical closure rates. Although the visual outcome may be limited by associated macular rpe atrophy or choroidal injury, there are encouraging reports of successful anatomical and functional. Spontaneous traumatic macular hole closure in a 50yearold. Traumatic macular hole formation is uncommon, and its exact etiology remains uncertain. The bestcorrected visual acuity bcva of the left eye was 2040. Rishi singh shows his technique for repairing a traumatic macular hole in a 22yearold patient injured by an airbag deploying during a car accident.
Serial oct imaging of the macular hole is useful in gauging ultimate visual recovery. A traumatic macular hole secondary to a highenergy nd. Intraoperative optical coherence tomography demonstrates. Amniotic membrane plug to promote chronicposttraumatic. Surgical repair was performed with pars plana vitrectomy ppv, internal limiting membrane peeling and autologous platelet. A macular hole is a small break in the macula, located in the center of the eyes lightsensitive tissue called the retina. A 50yearold greek woman was referred with a history of reduced. Yag laser is produced mainly by thermomechanical disruption or an optical breakdown of the tissue with some. Traumatic macular hole was documented with oct in five women and five men. Subhyaloid hemorrhage, traumatic macular hole, and electric burn springerlink. Traumatic macular hole c h a p t e r 42 traumatic macular hole wenlan zhang lejla vajzovic c h a p t e r ou t l i n e introduction 202 the brain connection 202 clinica. Subretinal blood and blood products damage retinal tissues through the toxic hindawi case reports in ophthalmological medicine. Modern vitrectomy surgery plays an important role in the treatment of tmh, although the functional outcomes may be compromised by the concomitant retinal pathologies.
We presented 4 cases of traumatic macular hole with different outcomes. Formation and treatment of a traumatic macular hole jama. A combination of surgical techniques to repair a giant traumatic macular hole soonwaichng,ibrahimelaraoud,davidkarl. The pathogenesis of macular hole formation after blunt trauma is today controversial. A 50yearold greek woman was referred with a history of. Traumatic macular hole tmh is not a rare clinical condition, especially in young population. Idiopathic macular hole is the most common presentation. Macular hole can be a result of severe damage from ocular concussion or damage to the retina. Macular holes can arise from different etiologies and can lead to vision loss. Surgical treatment of traumatic macular hole two case reports. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail. The patient presented with decreased vision in the left eye following blunt trauma 20 years prior. Retinal detachment secondary to traumatic macular hole youtube.
A yearold boy was hit in his left eye by a football. Like idiopathic macular holes, traumatic holes can be rehabilitated with vitrectomy. The mechanism of traumatic macular hole formation is more likely to result in avulsed tissue, and even after vitrectomy with wide internal limiting membrane peel. A 30 yo male patient presented with a retinal detachment secondary to a macular hole. The authors report a case of retinal detachment in an emmetropic eye secondary to development of a traumatic macular hole treated by removal of the internal limiting membrane ilm with a good visual outcome. Current management of traumatic macular holes ncbi. This video demonstrates surgery in a patient with traumatic macular hole. Nov 24, 2006 at 4 weeks after injury, a cuff of subretinal fluid was collected around the macular hole and a craterlike shaped swollen retina was seen around the hole at the oct images. Optical coherence tomography can play an essential role in patient management both at presentation and. A combination of surgical techniques to repair a giant. Although most macular holes are agerelated idiopathic conditions, that affect mainly female patients, they may also occur in association with trauma, thus being called traumatic macular holes. Optical coherence tomography can play an essential role in patient management both at presentation.
Because of foveal involvement, macular holes can be detrimental to visual acuity. Macular hole was first described in 1869 by knapp, 3 of a traumatic case. The pathogenesis of traumatic macular hole is not fully understood and the best treatment guidelines are controversial, especially in pediatric patients. Jun 04, 2019 a large traumatic macular hole poses a challenge to the vitreoretinal surgeon, because both characteristicslarge and traumaticare associated with lower surgical closure rates. They frequently appear immediately after the injury, nevertheless in some cases can occur weeks later. Fluid air exchange was done at the end of the surgery using continue reading surgery. Management of pediatric traumatic macular holes case report. We report on a case of a traumatic macular hole in a. Spontaneous closure or persistent opening of such holes can be found.
Spontaneous traumatic macular hole closure in a 50yearold woman. Traumatic macular hole occurs most often in young men and can present after various types of injuries. In the first case, a 9yearold boy presented with a traumatic macular hole. Macular hole reopening after successful surgical repair is well documented in the literature, and it is commonly caused by cataract surgery, growth of an epiretinal membrane erm, and development of cystoid macular edema cme. Risk factors include age, female gender, myopia, trauma, or ocular inflammation. A retinal detachment secondary to a macular hole is very. Traumatic reopening of macular hole following successful.
Though various treatments have been proposed, the management of traumatic macular holes is not widely standardized. Case presentation case a a 64yearold male patient with old central serous chorioretinopathy was treated by macular focal laser and subsequent photodynamic therapy 6 years ago in archives of ophthalmology and optometry volume 1, issue 1, 2018, pp. In the first case, a 9yearold boy presented with a traumatic macular hole secondary to blunt ocular trauma with a stone, and initial vision of 20300. A macular hole mh is a retinal break commonly involving the fovea. According to the literature, the frequency of traumatic macular holes is between 1% and 9%.
Pdf a mechanism for spontaneous closure of a traumatic. Closed traumatic macular hole in a 22yearold patient following surgical repair with the inverted ilm flap technique. Optical coherence tomography characteristics of full. Retrospective study of patients undergoing vitrectomy for traumatic macular hole and entered into the australian and new zealand society of retinal specialists surgical registry. Macular hole the macula is a small area in the center of the retina where light is sharply focused to produce the detailed color vision needed for tasks such as reading and driving.
Jan 14, 2012 macular hole can be a result of severe damage from ocular concussion or damage to the retina. We report on the closure of a chronic posttraumatic giant macular hole. Its prognosis is of complexity and uncertainty, with a relatively high rate of spontaneous closure in some cases. A posttraumatic macular hole ptmh is a complication of ocular trauma first described by herman knapp in 1869 1 and represents about. At 4 weeks after injury, a cuff of subretinal fluid was collected around the macular hole and a craterlike shaped swollen retina was seen around the hole at the oct images. Spontaneous closure occurs in approximately 50% of cases, but rarely after the age of thirty. Another theory proposes that a macular cyst caused by blunt trauma may later evolve into a macular hole. Variations of the inverted ilm flap technique have also been used. Subhyaloid hemorrhage can be described as the accumulation of blood and its confinement under hyaloid, which can cause severe visual impairment if located at macular region fig. A post traumatic macular hole ptmh is a complication of ocular trauma first described by herman knapp in 1869 1 and represents about 10% of all fullthickness macular holes ftmhs. We report a case of spontaneous closure of a full thickness macular hole due to a blunt trauma and we suggest possible mechanisms for this closure.
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