Spontaneous closure of traumatic macular hole

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.