THE ROLE OF VITREORETINAL SURGERY IN THE TREATMENT OF POSTTRAUMATIC MACULAR HOLE

Purpose: To determine if vitreoretinal surgery is successful in closin g traumatic macular holes and subsequently improving visual acuity. Bl unt trauma may result in a macular hole when it causes traumatic separ ation of the vitreous from the retina, contusion necrosis, or subfovea l hemorrhage. Like idiopathic macular holes, traumatic macular holes a re surrounded by a ring of subretinal fluid and result in severely dim inished visual acuity. Methods: Fourteen eyes with full-thickness post traumatic macular holes were treated. The patients' ages ranged from 1 5 years to 36 years (mean, 22 years). Preoperative best corrected visu al acuity ranged from 20/200 to 20/50 (mean, 20/80). A pars plana vitr ectomy and posterior hyaloid dissection were performed, followed by co mplete fluid-gas exchange and instillation of 0.1 mt of platelet conce ntrate just over the macular hole. A final flushing with 25% sulfur he xafluoride was done. The postoperative follow-up period ranged from 6 months to 28 months (average, 13 months). Results: Successful anatomic macular hole closure was achieved 6 months after surgery in 13 eyes ( 92.86%). Visual acuity improved four or more lines on the Snellen char t within 6 weeks after surgery in every eye with a closed hole; a fina l visual acuity of 20/20 was achieved in two eyes (15.3%). The mean po stoperative visual acuity was 20/30. No intraoperative or postoperativ e complications were noted, and the lens remained clear in all eyes du ring the follow-up period. Conclusion: Our results suggest that intrao perative application of platelet concentrate in combination with vitre ctomy may be useful in managing posttraumatic full-thickness macular h oles, thus improving anatomic and visual outcomes. The greater recover y of visual acuity obtained in this study compared with that obtained in other series of idiopathic macular holes could be related to the yo ung age of the patients with traumatic macular holes and the early dia gnosis and treatment.