Efficacy of early microincision vitrectomy surgery in traumatic macular hole

Abstract

Dear Editor, Traumatic macular hole (TMH) can cause severe visual disturbance, but spontaneous closure can nevertheless occur even after several months of observation and conservative treatment.[1, 2] Thus, vitreoretinal surgery for TMH remains controversial. However, failure to achieve closure after long-term conservative treatment is also possible in some cases,[1, 2] making early surgery for TMH a promising approach, particularly when using the most recent, sophisticated surgical options, such as microincision vitrectomy surgery (MIVS). Here, we performed a retrospective review of the medical records of 18 eyes of 18 patients (15 male and 3 female, mean age: 18.3 years) with TMH, all of whom underwent MIVS with 25-gauge (25G) or 27-gauge (27G) instruments. A posterior vitreal detachment was created within a safe range, followed by internal limiting membrane (ILM) peeling or inversion of the ILM flap, and at the end of surgery, we fully filled the vitreous cavity with gas in all cases. The optical coherence tomography (OCT)–measured minimal hole size, the period from trauma to MIVS, the anatomical closure rate, and the visual outcome were evaluated. The eyes were excluded based on a history of intraocular surgery, corneal opacity, use of intravitreal drugs such as anti-vascular endothelial growth factor, ocular inflammation, Emery-Little grade 3 or higher lens nuclei, and optic nerve disease. Table 1 summarizes the characteristics of the eyes and intraoperative and postoperative findings. Baseball injuries were the most common reason for TMH (14 of 18 eyes: 77.8%), and the mean hole size just before surgery was 312.5 ± 170.8 μm. All surgeries were performed under local anesthesia and used either 25G or 27G MIVS. The mean period from trauma to MIVS was 71.7 ± 44.2 days; 17 of 18 eyes (94.4%) underwent lens-sparing MIVS, while one eye underwent MIVS combined with cataract surgery (eye no. 18). Anatomical closure was obtained in 17 of 18 eyes (94.4%). Only two patients needed cryotherapy before and during MIVS (eyes no. 9 and 14, respectively). Best-corrected visual acuity (BCVA) recovered from a preoperative average of 0.65 ± 0.08 logarithm of the minimal angle of resolution (logMAR) to a postoperative average of 0.21 ± 0.07 logMAR (P < 0.001). There were no patients with a postoperative decrease in BCVA (Fig. 1a). Final postoperative BCVA in eyes with a period from trauma to MIVS of under 2 months was better than in eyes with a period of 2 months or more (0.10 and 0.35 logMAR, respectively; P = 0.04, Fig. 1b). The final postoperative BCVA in patients younger than 16 years was better than in patients 16 years or older (0.05 and 0.41 logMAR, respectively; P = 0.02, Fig. 1c). The mean postoperative follow-up period was 12.9 months. No surgical complications were observed, although one eye experienced cataract progression needing surgery (5.9%). Figure 1d–k shows a representative 14-year-old patient with a baseball injury-associated TMH (eye no. 13). This patient showed excellent, early recovery of post-MIVS BCVA. Several papers have reported positive outcomes after surgery for TMH. A single-arm meta-analysis showed that the closure rate and VA improvement were significantly This article is part of the topical collection on Macular Holes.