J Korean Ophthalmol Soc.  2014 Feb;55(2):312-316. 10.3341/jkos.2014.55.2.312.

A Case of Full Thickness Macular Hole Secondary to Old Traumatic Choroidal Rupture

• Kim BH
• Cha DM
• Yu HG

• KMID: 2218430
• DOI: http://doi.org/10.3341/jkos.2014.55.2.312

Abstract

PURPOSE
We report a case of a full-thickness macular hole which occurred many years after a blunt eye trauma leading to choroidal rupture.
CASE SUMMARY
A 50-year-old male visited our clinic with a complaint of decreased vision in his left eye 2 years in duration. He experienced a blunt trauma to his left eye with a baseball when he was 6 years old, although he did not complain of any visual disturbance in the left eye at that time. Fundus examination revealed a full-thickness macular hole with vertical fibrotic scar at the temporal side of the macula, which was thought to be a choroidal rupture induced by the previous blunt eye trauma. We performed vitrectomy and intravitreal tamponade injection. Two months later, the full-thickness macular hole completely closed and visual acuity of the left eye improved.

Keyword

Macular hole; Traumatic choroidal rupture; Vitrectomy

MeSH Terms

Baseball
Choroid*
Cicatrix
Humans
Male
Middle Aged
Retinal Perforations*
Rupture*
Visual Acuity
Vitrectomy

Figure

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  Figure 1. At the initial visit, fundus examination shows normal in the right eye and multiple linear parallel fibrotic scar temporal to the fovea with macular hole and an 1 disc diameter sized round RPE change at superotemporal proximal major vascular arcade were observed. Best corrected visual acuity was 20/50 in the left eye.

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  Figure 2. (A) Foveal vertical section, surface, and outer retinal images spectral-domain optical coherence tomography (SD-OCT) of the left eye. Stage 2 full thickness macular hole (MH) with retinal schisis at the margin of MH are observed. (B) Oblique section by spectral-domain optical coherence tomography (SD-OCT) of fibrotic scar of left eye. Several hyperreflective protrusion are observed at the subretinal pigment epithelial level.

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  Figure 3. Fluorescein angiography showed hyperfluorescence temporal to the fovea and the lesion of superotemporal proximal major vascular arcade due to atrophy of the retinal pigment epithelium in the early phase (A), stain of the dye in the late phase (B).

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  Figure 4. The comparison of 3 directional macular images and ILM-RPE thickness (μm) between the case of present study (A) and idiopathic macular hole (B). Macular thickness is increased with asymmetric traction line in the superonasal direction in the present case (A). But Symmetrically increased macular thickness is observed with anteroposterior traction of the vitreous in idiopathic macular hole (B).

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  Figure 5. Three months after the surgery, a closed MH and remnant foveal photoreceptor disruption are observed (A). Best corrected visual acuity improved to 20/32 in the left eye. Even after macular hole had been closed successfully, horizontal traction line (white arrow) was seen superior to the macular (B).

Reference

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