International Journal of Retina (IJRETINA) 2025.
Volume 8.
Number 2.
P-ISSN.
E-ISSN.
OBSERVATION VS.
SURGERY IN TRAUMATIC MACULAR HOLE:
A CASE REPORT HIGHLIGHTING FUNCTIONAL OUTCOME
Amelia Rahmah Kartika1.
Ima Yustiarini2.
Ady Dwi Prakosa2.
Sauli Ari Widjaja2.
Muhammad Firmansjah2.
Wimbo Sasono2 Faculty of Medicine Universitas Airlangga.
Dr.
Soetomo General Academic Hospital.
Surabaya.
Indonesia Vitreoretina Division.
Department of Ophthalmology.
Faculty of Medicine Universitas Airlangga.
Dr.
Soetomo General Academic Hospital.
Surabaya.
Indonesia Abstract Introduction: Traumatic macular hole (TMH) is a rare consequence of blunt ocular trauma, often leading to visual impairment.
While spontaneous closure is possible, the decision between observation and surgical intervention remains debated.
Case Report: A 15-year-old male presented with blurry vision in his left eye two weeks after being Examination revealed a macular hole, choroidal rupture, and vitreous hemorrhage.
Optical coherence tomography (OCT) confirmed a full-thickness macular hole.
Given the potential for spontaneous closure, a three-month observation period was chosen.
Follow-ups showed no improvement in visual acuity or anatomical closure, leading to the decision against surgery.
Discussion: While vitrectomy has high anatomical success rates, final visual acuity may not differ significantly between surgically and spontaneously closed holes.
Factors such as initial visual acuity, ellipsoid zone integrity, and associated ocular injuries influence functional outcomes.
this case, the presence of choroidal rupture and vitreous hemorrhage supported the decision for conservative management.
Conclusion: TMH management should balance anatomical and functional outcomes.
Observation is a reasonable approach in select cases, particularly in younger patients with a chance of spontaneous closure.
Individualized treatment decisions are essential, considering potential surgical risks and visual prognosis.
Keywords: Macular Hole.
Traumatic Macular Hole.
Blunt Ocular Trauma.
Functional Success Cite This Article: KARTIKA.
Amelia Rahmah.
OBSERVATION VS.
SURGERY IN TRAUMATIC MACULAR
HOLE: A CASE REPORT HIGHLIGHTING FUNCTIONAL OUTCOME.
International Journal of Retina, [S.
ISSN
Available <https://w.
com/index.
php/ijretina/article/view/322>.
Date accessed: 30 sep.
doi: https://doi.
org/10.
35479/ijretina.
Published by: INAVRS https://w.
org/ | International Journal of Retina https://ijretina.
INTRODUCTION
Macular hole (MH) is a vitreoretinal disorder characterized by a fullthickness defect in the neurosensory retina at the center of the macula, leading to visual impairment.
Traumatic macular hole (TMH) is the second most common cause of MH, primarily resulting from blunt ocular It is an uncommon complication of eye injury and is more frequently observed in young men and can develop immediately after injury or appear weeks later.
Ae.
Clinical presentation of TMH typically includes decreased visual acuity and Visual acuity in TMH cases varies widely, influenced by many factors.
Ae.
The management of TMH remains controversial, with no definitive guidelines on the optimal treatment approach.
While spontaneous closure can occur, particularly in young patients with smaller holes and an intact posterior vitreous.
Ae.
, surgical intervention is often considered for persistent cases.
Vitrectomy, first described for idiopathic macular holes (IMH.
, has been adapted for TMH repair, with reported anatomical closure rates exceeding 80%.
, 13Ae.
However, anatomical success does not always translate into functional success, as visual outcomes depend on multiple factors beyond hole closure.
, 9, .
This case report presents a young male patient who developed a TMH following blunt ocular We discuss the clinical presentation, considerations, highlighting the importance of weighing anatomical and functional outcomes when determining the best treatment strategy.
Correspondence to:
Amelia Rahmah Kartika.
Universitas Airlangga.
Dr.
Soetomo General Academic Hospital.
Surabaya.
Indonesia, ameliarkartika@gmail.
two weeks before admission to the hospital.
history of previous illnesses, use of glasses, or surgeries were reported.
On ocular examination, visual acuity (VA) was emmetropia on the right eye and 1 meter finger counting on the left eye.
Intraocular pressure (IOP) and ocular movement (OCM) were within normal limits on both eyes.
Anterior segment of left eye showed subconjunctival hemorrhage, others were within normal limit.
Posterior segments were also On funduscopy, the left eye showed choroidal rupture, macular hole, epiretinal membrane and vitreous hemorrhage, hence further evaluation was necessary.
Optic nerves were within normal limits.
Patient underwent Optical Coherence Tomography (OCT).
Left eye showed vitreous traction on the preretinal layer, disappeared foveal depression on the epiretinal layer, and full thickness macular hole on the intraretinal layer.
Right eye showed no Based on symptoms, signs, and imagings, the patient was assessed as post traumatic macular hole, choroidal rupture, vitreous hemorrhage, hemorrhage of the left eye.
Patient was planned to have a 3-month observation to evaluate the macular hole closure.
Patient was discharged and prescribed some medications such as tranexamic acid b.
, eye drop levofloxacin q.
, and eye lubricant q.
CASE REPORT
A 15-year-old male patient presented with a complaint of blurry vision in the left eye for the past two weeks.
Blurred vision was defined as seeing straight lines appear bent and noticing floating threads sometimes.
The patient mentioned a history of being punched on the eye by his friend Published by: INAVRS https://w.
org/ | International Journal of Retina https://ijretina.
Fowler position bed rest during the take-home medication was also suggested, and the patient was planned to be followed-up on the next 4 Figure 1.
(A) Subconjunctival hemorrhage seen in the left eye (B) on Funduscopy, retina showed retina: choroidal rupture, macular hole and vitreous hemorrhage (C) OCT of the left eye showed preretinal vitreous traction, epiretinal foveal depression disappeared with intraretinal full thickness macular hole.
At four weeks follow-up, the left eye showed decreased subconjunctival hemorrhage and seemed no improvement on both funduscopy and OCT.
Three-month observation management continued, the patient was discharged and planned to be followed up on the next 6 weeks.
At the next six weeks follow-up, the left eye showed no subconjunctival hemorrhage but funduscopy and OCT still showed no closure of the macular hole.
Published by: INAVRS https://w.
org/ | International Journal of Retina https://ijretina.
Figure 2.
(A) Subconjunctival hemorrhage decreased (B & C) funduscopy and OCT remained the same.
Figure 3.
(A) Subconjunctival hemorrhage is gone (B & C) there are no improvements in funduscopy and OCT.
All the visual acuity on the follow up time remain 1 meter finger counting on the left Because vitreous traction and an epiretinal membrane were found around the macular hole on funduscopy, the likelihood of spontaneous closure is The patient was then educated that the prognosis for surgical intervention is poor.
The patient's family and the patient subsequently refused the procedure, and the doctor and patient agreed to proceed with conservative management.
DISCUSSION