Spontaneous closure of a traumatic macular hole: The fastest yet?

Oscar Eaton; Francesc March de Ribot

doi:10.4103/ijo.IJO_1931_22

PHOTO ESSAY

Year : 2023 | Volume : 3 | Issue : 2 | Page : 572-573

Spontaneous closure of a traumatic macular hole: The fastest yet?

Oscar Eaton¹, Francesc March de Ribot²
¹ Department of Ophthalmology, Dunedin Hospital, Dunedin, New Zealand
² Department of Ophthalmology, Dunedin Hospital; Department of Ophthalmology, The University of Otago, Dunedin, New Zealand

Date of Submission	06-Dec-2022
Date of Acceptance	05-Jan-2023
Date of Web Publication	28-Apr-2023

Correspondence Address:
Oscar Eaton
Department of Ophthalmology, Dunedin Hospital, 201 Great King Street, Dunedin 9016
New Zealand

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1931_22

Abstract

Keywords: Macular hole, spontaneous closure, traumatic

How to cite this article:
Eaton O, de Ribot FM. Spontaneous closure of a traumatic macular hole: The fastest yet?. Indian J Ophthalmol Case Rep 2023;3:572-3

How to cite this URL:
Eaton O, de Ribot FM. Spontaneous closure of a traumatic macular hole: The fastest yet?. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 6];3:572-3. Available from: https://www.ijoreports.in/text.asp?2023/3/2/572/374916

A man in his 20s presented to our eye department following blunt trauma to the right eye from a paint ball gun earlier that day. The visual acuity (VA) of the affected eye was 1/60, the intraocular pressure (IOP) was 14 mmHg, and the anterior segment was normal. Posterior segment examination revealed a full-thickness elliptical macular hole with perimacula edema and scattered intraretinal hemorrhage and edema throughout the periphery [Figure 1]a. On ocular coherence tomography (OCT), the narrowest internal diameter of the defect measured 148 μm [Figure 1]b. There was presence of vitreomacular adhesion with overlying operculum, localized detachment of the neurosensory retina, and absence of cystic edema at the hole margin [Figure 1]b. On review 4 days after injury, spontaneous closure was observed [Figure 1]c. The examination revealed complete posterior vitreous detachment with apposition of the macular hole, increased retinal thickness, and atrophic changes. The patient was reviewed again at 3 months and the VA was found to be 1/60. There was restoration of the foveal pit and progression of the inferotemporal macular atrophy.

Figure 1: (a) Color photograph of the right fundus at 4 h after the trauma, showing a full-thickness macular hole surrounded by retinal edema. Original image. (b) OCT horizontal axis image demonstrating base width 1969 μm and narrowest width 148 μm. Original image. (c) OCT demonstrating closure of macula hole at day 4. Original image. OCT = optical coherence tomography

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Discussion

Spontaneous closure of traumatic macular holes has been reported many times before, with a varied time course of between 2 and 54 weeks.^[1],[2] Closure under 2 weeks is rare, with the earliest reported being 10 days.^[3] Classification of traumatic macular hole based on OCT findings can aid in the prediction of hole closure.^[4] In this case, the absence of posterior vitreous detachment at the time of injury and the absence of cystic edema at the hole margin were associated with hole closure. Spontaneous closure is usually associated with improvement in VA,^[5] although the severity of initial trauma and the extent of neurosensory retinal detachment can limit the visual outcome, as in this case.

Patient consent

Oral consent has been obtained to allow publication of the case and inclusion of imaging.

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

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3.	Misra DK, Barman M, Deori N, Upadhyay A. Hyperacute spontaneous closure of a traumatic macular hole in a colobomatous eye. Am J Ophthalmol Case Rep 2019;15:100504. doi: 10.1016/j.ajoc. 2019.100504.
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