About OJO | Search | Ahead of print | Current Issue | Archives | Author Instructions | Reviewer Guidelines | Online submissionLogin 
Oman Journal of Ophthalmology Oman Journal of Ophthalmology
  Editorial Board | Subscribe | Advertise | Contact
https://www.omanophthalmicsociety.org/ Users Online: 1866  Wide layoutNarrow layoutFull screen layout Home Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents    
CASE REPORT
Year : 2016  |  Volume : 9  |  Issue : 2  |  Page : 107-109  

Spontaneous closure of macular hole following blunt trauma


1 Department of Retina, Centro Brasileiro da Visao, Brasília-DF; Department of Retina, Hospital de Olhos Santa Luzia, Recife-PE, Brazil
2 Department of Retina, Centro Brasileiro da Visao, Brasília-DF, Brazil
3 Department of Retina, Hospital de Olhos Santa Luzia, Recife-PE, Brazil
4 Department of Retina, Centro Brasileiro da Visao, Brasília-DF; Department of Retina, Hospital de Olhos Santa Luzia, Recife-PE; Department of Ophthalmology, Federal University of Goiás, Goiania-GO, Brazil
5 Department of Retina, Centro Brasileiro da Visao, Brasília-DF; Department of Ophthalmology, Federal University of Goiás, Goiania-GO, Brazil

Date of Web Publication23-Jun-2016

Correspondence Address:
Clovis Arcoverde Freitas-Neto
Hospital de Olhos Santa Luzia, Estrada do Encanamento 909, Casa Forte, Recife - PE, 52070-000
Brazil
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-620X.184530

Rights and Permissions
   Abstract 

Ocular trauma can result in macular hole and it can lead to complete loss of central vision. We are reporting a case of traumatic macular hole associated with retinal hemorrhages and choroidal ruptures with spontaneous resolution and total vision recovery.

Keywords: Brief report, eye injuries, macular hole, retina


How to cite this article:
Freitas-Neto CA, Pigosso D, Pacheco KD, Pereira VO, Patel P, Freitas LG, Avila MP. Spontaneous closure of macular hole following blunt trauma. Oman J Ophthalmol 2016;9:107-9

How to cite this URL:
Freitas-Neto CA, Pigosso D, Pacheco KD, Pereira VO, Patel P, Freitas LG, Avila MP. Spontaneous closure of macular hole following blunt trauma. Oman J Ophthalmol [serial online] 2016 [cited 2019 Dec 6];9:107-9. Available from: http://www.ojoonline.org/text.asp?2016/9/2/107/184530


   Introduction Top


Macular holes can develop following intraocular inflammatory diseases, trauma, vitreous detachment, among others. The posttraumatic macular hole (TMH) may be due to vitreomacular tractions, subfoveal hemorrhage or by the physical response to the injury. Optical coherence tomography (OCT) can identify slight retinal changes as Grade 1 macular holes. Macular holes following ocular trauma can be thoroughly evaluated by OCT and when the hole persists vitreoretinal surgery can be recommended. [1],[2],[3],[4]

When indicated, TMH surgery has traditionally been successfully performed by pars plana vitrectomy with gas tamponade and patient face-down positioning. [5] Young patients with TMH should wait at least 6 months from the date of the ocular trauma due to the possibility of spontaneous closure. [6] Herein, we report a case of TMH associated with subfoveal hemorrhage and choroidal rupture that recovered spontaneously the macular anatomy and visual acuity.


   Case Report Top


We report a 38-year-old female with sudden decreased of vision in her left eye following blunt trauma by a punch. Her best-corrected visual acuity was 20/20 in the right eye and hands movements in the left. Slit-lamp examination of the affected eye showed conjunctival injection, clear and compact cornea, no evidence of superficial damage to the eyeball, and no lens injury. Left eye fundus examination and fundus color retinography showed subretinal macular hemorrhage. OCT revealed full thickness macular hole and hyperreflective subretinal deposits corresponding to the submacular hemorrhage [Figure 1].

No intervention was done. In the follow-up visit, the visual acuity in the right eye improved from hand movement to 20/60 and the OCT showed persistent macular hole and partially absorption of the hemorrhage. Fundoscopy revealed a linear whitish lesion concentrically to the optic disc suggesting choroidal rupture. Because of the visual acuity improvement and good absorption of hemorrhage, the patient was advised to return to clinic in 3 months. Three months later, the visual acuity recovered to 20/20. OCT and fundus photographs registered complete resolution of TMH and retinal hemorrhage absorption [Figure 2].
Figure 1: (a) Retinal hemorrhage involving the fovea. (b) Optical coherence tomography shows full-thickness traumatic macular hole with hyperreflective subretinal deposits corresponding to hemorrhage

Click here to view
Figure 2: (a) Color retinography demonstrating complete hemorrhage absorption and a hypopigmented lesion concentrically to the optic disc, suggesting choroidal rupture (white arrow). (b) Optical coherence tomography showing macular hole closure with alignment of all retinal layers

Click here to view



   Discussion Top


There are two possible mechanisms in the pathogenesis of TMH: One causes visual loss by immediate and direct foveal detachment; the other is due to vitreous-macular traction. The spontaneous closure of the TMH may occur and observation can be the treatment of choice. [1],[2],[3],[4] Yamashita et al. published a case series of 18 eyes with TMH where 44% of the eyes showed spontaneous hole closure. They suggested that observation for a period of at least 4 months may be the management of choice. [5] In the described case, during the follow-up without surgical intervention, the macular hole resolved gradually and the visual acuity recovered within 3 months.

Technological advances in equipment and the continuous development of less invasive techniques for vitrectomy surgery lead to retinal surgeons perform intraocular procedures with better anatomic and visual results with fewer complications. Even when dealing with a procedure with little complication rates, the vitrectomy for macular holes presents risks. Proper surgical technique for the post-TMH has not been established. Ghoraba et al. showed that vitrectomy with gas tamponade is more successful in the anatomical closure of TMHs than silicone oil tamponade. [6] Surgery for full thickness macular holes can reestablish foveal morphology in approximately 90% of cases. Pars plana vitrectomy may improve final visual acuity but there are risks of complications such as endophthalmitis and retinal detachment. Risks are similar to surgery for nontraumatic holes. [7],[8],[9] Because of the chance of spontaneous closure without surgical intervention, it was decided to observe through fundus examination, OCT and visual acuity monitoring. Three months after the trauma, the patient presented with macular hole closure and excellent visual acuity.


   Conclusion Top


Caution is needed before surgical intervention in cases of TMH. Monitoring the visual acuity and the anatomic changes of the macular hole by OCT may be the therapy of choice since spontaneous closure is possible.

Acknowledgment

The authors would like to thank Ninani Kombo for the English language review and critical analysis of this paper.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Mitamura Y, Saito W, Ishida M, Yamamoto S, Takeuchi S. Spontaneous closure of traumatic macular hole. Retina 2001;21:385-9.  Back to cited text no. 1
    
2.
Bonnin N, Cornut PL, Chaise F, Labeille E, Manificat HJ, Feldman A, et al. Spontaneous closure of macular holes secondary to posterior uveitis: Case series and a literature review. J Ophthalmic Inflamm Infect 2013;3:34.  Back to cited text no. 2
    
3.
Chen H, Zhang M, Huang S, Wu D. OCT and muti-focal ERG findings in spontaneous closure of bilateral traumatic macular holes. Doc Ophthalmol 2008;116:159-64.  Back to cited text no. 3
    
4.
Sartori Jde F, Stefanini F, Moraes NS. Spontaneous closure of pediatric traumatic macular hole: Case report and spectral-domain OCT follow-up. Arq Bras Oftalmol 2012;75:286-8.  Back to cited text no. 4
    
5.
Yamashita T, Uemara A, Uchino E, Doi N, Ohba N. Spontaneous closure of traumatic macular hole. Am J Ophthalmol 2002;133:230-5.  Back to cited text no. 5
    
6.
Ghoraba HH, Ellakwa AF, Ghali AA. Long term result of silicone oil versus gas tamponade in the treatment of traumatic macular holes. Clin Ophthalmol 2012;6:49-53.  Back to cited text no. 6
    
7.
Johnson RN, McDonald HR, Lewis H, Grand MG, Murray TG, Mieler WF, et al. Traumatic macular hole: Observations, pathogenesis, and results of vitrectomy surgery. Ophthalmology 2001;108:853-7.  Back to cited text no. 7
    
8.
Minihan M, Goggin M, Cleary PE. Surgical management of macular holes: Results using gas tamponade alone, or in combination with autologous platelet concentrate, or transforming growth factor beta 2. Br J Ophthalmol 1997;81:1073-9.  Back to cited text no. 8
    
9.
la Cour M, Friis J. Macular holes: Classification, epidemiology, natural history and treatment. Acta Ophthalmol Scand 2002;80:579-87.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]



 

Top
   
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed2165    
    Printed24    
    Emailed0    
    PDF Downloaded151    
    Comments [Add]    

Recommend this journal