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Traumatic macular hole

A young 12 years old boy referred to me for reduced vision in his left eye (Vision 20/320). His fundus exam shows chorioretinal atrophy circulating the optic nerve with glossy wrinkles of the inner retinal tissue at the macula and macular hole formation adjacent to full-thickness macular tissue loss and chorioretinal atrophy and yellow deposits. The other eye exam is normal; however patient denies any systemic nor traumatic history 


Traumatic macular hole

Traumatic macular hole




Optical coherence tomography 

The OCT scan shows a full-thickness retinal macular hole (530 microns) with pseudo cystic changes more prominent on the temporal side; however, there is RPE atrophy nasal side adjacent to the optic disc.


OCT of Traumatic macular hole

OCT of Traumatic macular hole




Diagnosis 

is a traumatic macular hole

Pathogenesis

Pathogenesis, in contrast to idiopathic macula hole vitreous macular traction, is not involved in the mechanism of hole formation. It is caused by anterior, posterior globe flattening, which induces perpendicular stretch of the macula, inducing macular hole formation

Management

 usually in the small holes observation for two or three months is enough for spontaneous closure but in large holes. This situation indicates pars plana vitrectomy with ILM peeling.

Prognosis

Prognosis guarded as it is unknown when the trauma and hole happened 


#Hole #Macula #Retina #OCT

Check clinical guidelines for Posterior segment trauma




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