Title

SPONTANEOUS CLOSURE OF TRAUMATIC LAMELLAR HOLE: CASE REPORT

Introduction

Traumatic macular holes are a rare condition, more often related to blunt eye injuries, that can cause permanent visual loss and scotomas. The treatment can be interventionist although spontaneous closure occurs until 3 months after trauma. In this paper we aimed to discuss a case of traumatic lamellar hole with conservative treatment.

Methods

Case report of a 23 yo patient and correlation to previous literature.

Results

Male, 23 yo, presented with vision loss and central scotoma in the left eye following blunt eye injury during soccer. Best-corrected visual acuity 20/25 in the right eye and 20/150 in the left eye (peripheric field). Slit-lamp examination of the affected eye showed conjunctival injection, clear and compact cornea, no evidence of superficial damage to the eyeball, and no lens injury. Left eye fundus examination and retinography showed blurred optic nerve, hemorrhages in papillary-macular axis and inferior temporal retina and peripherical degenerations. OCT revealed lamellar hole in OS. Underwent panphotocoagulation of periphery and conservative treatment. During the 3 months follow up, visual acuity of OS improved to 20/70 without scotomas. The OCT image showed complete hole closure and reorganization of retina layers.

Discussion

Traumatic lamellar holes are usually consequence of a blunt eye injury, more frequently occurring in patients with previous retinal alterations. The pathophysiology includes extrinsic force against the globe that can lead to alterations in the vitreoretinal interface. The treatment is individualized from observation to vitrectomy. Spontaneous closure occurs in 40% of all patients after 2 weeks to 3 months of follow-up. Seriated OCT analysis can help to predict the outcome, since an increasing size hole is a worse prognostic factor. Young patients with minor alterations in OCT image are eligible for conservative treatment before deciding for vitrectomy. Our patient improved anatomic and functionally during the 3 months following the trauma.

Keywords

Traumatic; macular; hole

Area

CLINICAL CASE

Authors

Thiago Carvalho e Silva Figueiredo, Isabela Vianello Valle, Milena de Arruda Sousa Pacheco, Tiago Almeida Carvalho, Vinicius Clementino Falcão, Bruno Baldissera Tochetto, Fernanda Nonato Federici, Natália Belo Rodrigues