Traumatic Macular Hole in Children: Characteristics, Management and Outcomes

Purpose: To describe the characteristics and outcomes of traumatic macular holes in children. Methods: In this retrospective, consecutive case series, patients <18 years with a diagnosis of post-traumatic macular hole with a minimum of 3-month follow-up were included. They were either observed or underwent pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. The rate of macular hole closure with and without surgery, and factors associated with spontaneous closure were reccorded. Results: A total of 44 patients with a mean age at presentation of 12.3±3 years (range: 3-17) were included. Mean minimal linear diameter (MLD) was 497±102 μm (range: 60-1400) and mean base diameter was 1342±266μm [range: 132-4000]. Spontaneous closure was observed in 15 eyes (34.1%) after a mean interval of 48±61 days (range: 7-210) following trauma. Macular hole surgery with PPV and ILM peeling was performed in 25 eyes (56.8%), a surgical closure rate was achieved in 80% of cases. Spontaneous closure was associated with smaller MLD (277.8±145.3μm vs. 610.8±370.9μm, p=0.002), macular serous retinal detachment (p=0.02), vitreous hemorrhage (p=0.05), and hyphema (p=0.02). Conclusion: Trauma is the most common etiology of pediatric MH. Spontaneous closure is frequent, occurring in almost one third of patients with smaller MLD. Surgery offers a relatively good MH closure rate in 80% cases. Visual improvement was similar between eyes with spontaneous closure and those following surgical closure.