Atlas of Ophthalmology

Traumatic Macular Hole (Colour Fundus Photography, SD-OCT, VEP)

Retina -> Traumas
Patient: 14 years of age, male, BVCA 1/50 LT at OD, 1.0 at OS. General Medical History: empty. Ocular Medical History: in the age of 10 years suffering from an ocular blunt trauma as a sport-related accident with a soccer ball, leading to a hemorrhage of the lid and a decreased vision at OD of 0.3. Main Complaint: Decreased stereo vision in sports. Purpose: to demonstrate the effect of a blunt ocular trauma with a soccer ball. Methods: Colour Fundus Photography, SD-OCT (Spectralis, Heidelberg Engineering, Heidelberg), Visual Evoked Potential (VEP). Findings: Colour Fundus Photography: stage 2, full-thickness macular hole, not complicated by epiretinal membrane, cuff of subretinal fluid, or posterior vitreous detachment. SD-OCT: stage 2 macular hole with a disrupted external limiting membrane (ELM) and a disrupted photoreceptor inner segment–outer segment junction (IS/OS). The retinal pigment epithelium (RPE) was regular. Parafoveal cystoid spaces were visible which are believed to correspond to Henle’s fibers in the outer plexiform layer. SD-OCT Circular Scan: Decreased retinal nerve layer thickness in the temporal and superior area. Visual Evoked Potential (VEP): Diminuished potentials. Discussion: Traumatic macular formation may cause immediate visual loss due to primary dehiscence of the fovea, or may lead to delayed visual loss due to dehiscence of the fovea secondary to persistent vitreofoveal adhesion. Spontaneous closure of traumatic macular hole is not uncommon. Yamashita et al. (1) reported a consecutive series of 18 eyes of 18 patients with traumatic macular hole. The major cause of blunt trauma was sports-related accidents. 33% developed visual symptoms immediately after trauma. He found that 44% achieved spontaneous closure of traumatic macular hole 1 week to 4 months after trauma with the final best-corrected visual acuity of 0.5 or better in 50% of eyes with spontaneous closure. He suggested that an observation for a period of up to four months may be a management of choice for traumatic macular hole. Literature (1) Yamashita T, Uemara A, Uchino E, Doi N, Ohba N. Spontaneous closure of traumatic macular hole. Am J Ophthalmol. 2002 Feb;133(2):230-5

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