Spontaneous closure of traumatic macular holes

Objective

To present a series of cases with spontaneous closure of traumatic macular hole.

Design

Case series.

Participants

Six eyes of 6 patients with traumatic macular hole.

Methods

The characteristics of eyes with macular hole secondary to blunt trauma in which the macular hole closed spontaneously without surgical manipulation were reviewed.

Results

Patient age range was 13 to 55 years. There were 4 full-thickness and 2 lamellar macular holes. Spontaneous closure occurred after 1 to 6 months of observation. Best corrected visual acuity improved in 5 eyes and remained unchanged in the other eye.

Conclusions

Spontaneous closure of traumatic macular holes may occur within 6 months after initial presentation.     

Spontaneous closure of traumatic macular hole

Macular hole formation is a well-known complication following ocular trauma. Less commonly recognised is the spontaneous closure of such holes.A 27-year-old man presented with a history of blunt trauma to his left eye. Eye evaluation showed conjunctival laceration, diffuse retinal oedema and multiple retinal haemorrhages in that eye. A month later, he developed a full thickness macular hole. Two months later, there was spontaneous complete closure of the full-thickness macular hole in the left eye as confirmed on optical coherence tomography.Spontaneous closure of hole is not uncommon. Observation for a period of up to 12 months is a reasonable management option. Macular hole surgery for traumatic macular holes may be delayed in such cases.     

Spontaneous closure of traumatic macular hole

PURPOSE: To investigate the mechanism by which traumatic macular hole closes spontaneously. DESIGN: Consecutive observational case series of three patients with unilateral traumatic macular hole who consulted medical staff at the Kansai Medical University between 1997 and 2000. METHODS: Three patients who sustained unilateral blunt trauma to the eye and developed traumatic macular hole were followed with ophthalmic examination, fundus photography, fluorescein angiography, and optical coherence tomography (OCT). RESULTS: Case 1 was an 11-year-old boy. He had neither a macular hole nor prominent macular edema at his first consultation, but a macular hole opened 3 weeks later. OCT showed macular edema and a full-thickness macular hole. The tissue around the edge of the macular hole protruded inward toward the center and finally closed spontaneously 18 weeks later. Case 2 was a 19-year-old man. He had a tiny rough-edged macular hole at his first consultation with a local ophthalmologist. OCT showed macular hole enlargement and worsening of the macular edema during follow up. The macular hole finally closed 4 months after injury. Case 3 was a 15-year-old boy. He had a tiny rough-edged macular hole at his first consultation with a local ophthalmologist. The macular hole finally closed 6 months after injury. CONCLUSION: Macular hole can be a result of severe damage from ocular concussion or damage to the retina. For 6 months following injury, traumatic macular hole should probably be observed rather than surgically repaired, because of the possibility that the macular hole may close spontaneously.     

Spontaneous closure of traumatic macular hole.

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.     

Spontaneous closure of full thickness traumatic macular holes

CASE REPORT: We present case reports of two young patients suffering from full thickness traumatic macular holes resulting in visual impairment of more than 60%. Both showed anatomical and visual improvement whilst waiting for surgical treatment. DISCUSSION: Spontaneous closure of a traumatic macular hole is an unusual outcome. OCT and clinical follow up enabled monitoring of this resolution during a period of a few weeks. Complex surgery was thus avoided by a short observational period.     

Spontaneous closure of full-thickness macular hole in type 2 idiopathic macular telangiectasia

Graefe's Archive for Clinical and Experimental Ophthalmology -     

Spontaneous closure of macular hole after posterior vitreous detachment

Macular holes can be treated with surgically-induced vitreous detachment and gas tamponade. The authors report a case of a macular hole that closed spontaneously after the development of posterior vitreous detachment (PVD). Optical coherence tomography (OCT) revealed a small full-thickness macular hole with perifoveal cystic changes in a 25-year-old female with a central scotoma at her initial visit. There was no evidence of PVD. Five months later, PVD was observed and the macular hole disappeared. OCT performed three months later showed macular hole closure and resolution of the perifoveal cystic changes. The physiologic pit was restored in the fovea. OCT is useful to detect and monitor the morphologic changes of a macular hole.     

Spontaneous closure of a stage III idiopathic macular hole

CASE REPORT: We report spontaneous closure of an idiopathic 200 microm stage III macular hole, confirmed by optical coherence tomography, in a 76-year-old woman. COMMENTS: Spontaneous closure is rare and not well understood. Possible mechanisms are discussed. Delay of surgery is not recommended.     

Spontaneous closure of macular holes developed after pars plana vitrectomy

PURPOSE: To report a small, retrospective, noncomparative case series (3 patients) of idiopathic macular holes with spontaneous closure in previously vitrectomized eyes. METHODS: The first patient developed a macular hole 14 months after vitrectomy for penetrating ocular trauma. In the rest of the patients, the macular holes were documented ten days and two months after vitrectomies for retinal detachment. RESULTS: In all cases the macular holes resolved spontaneously 2 years, 6 and 9 months after their documentation, respectively. CONCLUSIONS: Despite the limitations placed by the small sample of studied patients, it seems that spontaneous closure of macular holes developed after vitrectomy can happen as part of their natural course. Both pathogenetic and repair factors involved in macular hole can act spontaneously in a vitrectomized eye.     

Spontaneous closure of lamellar macular holes studied by optical coherence tomography

Purpose: To document and study the spontaneous closure of lamellar macular holes (LMH) by optical coherence tomography (OCT). Methods: Two women with LMH, 62 and 71 years old, respectively, were followed up with fundoscopy, fundus photography and OCT. Results: In both patients spontaneous closure of LMH was observed 11 and 21 months after baseline examination, respectively. The foveal thickness in case 1 increased from 84 μm at baseline to 162 μm at the final examination. The foveal thickness in case 2 increased from 48 μm at baseline to 148 μm at the final examination. The foveal contour was also restored in both eyes. The foveal morphology was preserved in both eyes during the follow‐up period. Conclusion: In both patients the spontaneous closure of LMH could be attributed to the shrinkage of the hole or the release of the tension on the retinal surface, which followed the complete posterior vitreous detachment and separation of epiretinal membrane from the retina.     

Spontaneous closure of a large traumatic macular hole in a young patient

PURPOSE: To report the spontaneous resolution of a traumatic macular hole that was considerably larger than in previously reported cases.DESIGN: Observational case report. METHODS: The clinical and angiographic data of the patient were reviewed.RESULTS: A traumatic 600 x 400 micro macular hole was observed to spontaneously resolve 5 weeks after trauma in a 15-year-old patient. Visual acuity only slightly improved consequently (from counting fingers at 4 meters to 20/200). The clinical appearance of the fovea after macular hole resolution raised the suggestion that a postconcussion retinal necrosis was the mechanism behind the lesion formation in this case.CONCLUSIONS: Spontaneous resolution of a traumatic macular hole is an outcome not limited to small lesions. Larger macular holes may represent retinal tissue loss and consequently a less favorable visual prognosis.     

OCT and muti-focal ERG findings in spontaneous closure of bilateral traumatic macular holes

Purpose To report the spontaneous closure of bilateral traumatic macular holes in a young patient, followed up with optical coherence tomography (OCT), muti-focal electroretinogram (mfERG), and Humphrey visual field examination. Methods A 25-year-old male who suffered from bilateral blunt trauma to the eyes and developed traumatic macular holes was followed with ophthalmic examination, OCT, mfERG, and Humphrey visual field examination. Results The OCT results revealed spontaneous closure in both eyes 2 weeks after trauma, and the macular holes remained closed in the 7 months of follow-up. Visual acuity improved to 0.7 in right and 0.9 in left eye finally. Visual field examination and mfERG results improved slightly compared with the initial tests. However, there still were central scotomas in both eyes, especially in right eye at the end of follow-up, and the peaks of the retinal response density had not recovered in the macular area of the mfERG topography. Conclusions Spontaneous closure of unilateral traumatic macular hole is not uncommon, but there is no report of spontaneous closure of bilateral traumatic macular holes as yet. Since the traumatic macular holes may close spontaneously, traumatic macular holes may be observed for a period of follow-up.     

Spontaneous closure of stage 2 macular hole observed with optical coherence tomography

PURPOSE: To report the clinical course and images of optical coherence tomography of an eye with a stage 2 macular hole which closed spontaneously. DESIGN: Observational case report. METHODS: Serial optical coherence tomographic images were obtained. RESULTS: A 67-year-old woman received a diagnosis of stage 2 idiopathic macular hole in her right eye. The diagnosis was made with a tomographic image of a full-thickness dehiscence of the neurosensory retina at the fovea. The posterior hyaloid membrane was adhering to the edge of the dehiscence. Four weeks later, the closure of the macular hole was ascertained with optical coherence tomography. The posterior hyaloid membrane was fully separated from the fovea. CONCLUSION: A stage 2 macular hole may close spontaneously with the separation of the hyaloid membrane.