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 Table of Contents    
CLINICALIMAGE
Year : 2020  |  Volume : 13  |  Issue : 2  |  Page : 98-99  

Spontaneous closure of a large traumatic macular hole


1 Department of Ophthalmology, All India Institute of Medical Sciences, Mangalagiri, Guntur, Andhra Pradesh, India
2 Department of Vitreo-Retina, Aravind Eye Care System, Puducherry, India

Date of Submission23-Apr-2019
Date of Decision28-Mar-2020
Date of Acceptance30-Mar-2020
Date of Web Publication28-May-2020

Correspondence Address:
Pratyusha Ganne
Department of Ophthalmology, All India Institute of Medical Sciences, Mangalagiri, Guntur - 522 503, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_99_2019

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   Abstract 


Spontaneous closure of a large traumatic macular hole is a rare event. We report a case of a large traumatic macular hole in a 16-year-old that closed spontaneously following an epiretinal membrane formation. Centripetal contraction of the membrane resulted in hole closure and subsequent improvement in visual acuity.

Keywords: Epiretinal membrane, macular hole, spontaneous, traumatic


How to cite this article:
Ganne P, Krishnappa NC, Velis G. Spontaneous closure of a large traumatic macular hole. Oman J Ophthalmol 2020;13:98-9

How to cite this URL:
Ganne P, Krishnappa NC, Velis G. Spontaneous closure of a large traumatic macular hole. Oman J Ophthalmol [serial online] 2020 [cited 2020 Jul 6];13:98-9. Available from: http://www.ojoonline.org/text.asp?2020/13/2/98/285307



Traumatic macular hole can form immediately after trauma or a few weeks later. The exact pathogenesis of a full-thickness macular hole following trauma is uncertain. It could result from a rupture of the fovea due to the impact of the injury (early onset) or de-roofing of the cysts in chronic cystoid macular edema (late onset).[1] Spontaneous closure has been reported to occur for small traumatic macular holes in young patients.[1],[2],[3] We report spontaneous closure of a large macular hole in a young boy following trauma and postulate the possible mechanisms underlying it.

A 16-year-old boy presented with a large macular hole 10 days after a blunt trauma to his left eye. Best-corrected visual acuity (BCVA) was 20/200 in that eye. Anterior-segment examination showed traumatic iritis, which was treated with topical steroids and cycloplegics. The hole diameter on optical coherence tomography (OCT) was 732 μm [Figure 1]a. One edge of the hole was flat and the other elevated. There were very few intraretinal cysts. After a week, we noticed the development of an epiretinal membrane (ERM) around the macular hole [Figure 1]b and [Figure 1]c. Over the next 20 days, the hole size decreased and the hole closed spontaneously after 3 months. The BCVA improved to 20/80.
Figure 1: (a) Optical coherence tomography scan through the left macula showing a full-thickness macular hole of 732 μm. One edge of the hole is flat and the other elevated. No intraretinal cysts are seen. (b) Optical coherence tomography scan taken after 3 months showing a type 1 closure of the macular hole with a thick epiretinal membrane. Foveal detachment (asterisk) is also present which settled over the next 1 year. (c) Color fundus photograph of the left eye showing an epiretinal membrane (arrow head) with a closed macular hole. Also seen are a few splinter hemorrhages and tortuous macular blood vessels

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Spontaneous closure of the traumatic macular holes has been rarely reported in literature. Edges of the hole get apposed by contracting fibroglial cells. Larger holes are caused by severe traumatic forces, resulting in significant retinal necrosis and tissue loss. Hence, the chance for spontaneous closure is low.[4] In a study by Chen et al., holes that underwent spontaneous closure had a small minimum diameter (244.9 ± 114.4 μm) and less intraretinal cysts on OCT.[3]

In the present case, vigorous fibroglial proliferation resulted in an ERM development. Centripetal contraction forces brought the two edges together, resulting in the approximation of hole edges. Hence, a close follow-up of traumatic macular holes can avoid surgical intervention in some cases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
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. 1
    
2.
Faghihi H, Ghassemi F, Falavarjani KG, Saeedi Anari G, Safizadeh M, Shahraki K. Spontaneous closure of traumatic macular holes. Can J Ophthalmol 2014;49:395-8.  Back to cited text no. 2
    
3.
Chen H, Chen W, Zheng K, Peng K, Xia H, Zhu L. Prediction of spontaneous closure of traumatic macular hole with spectral domain optical coherence tomography. Sci Rep 2015;5:12343.  Back to cited text no. 3
    
4.
Yeshurun I, Guerrero-Naranjo JL, Quiroz-Mercado H. Spontaneous closure of a large traumatic macular hole in a young patient. Am J Ophthalmol 2002;134:602-3.  Back to cited text no. 4
    


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