Excellent visual outcome after vitrectomy for traumatic macular hole associated with choroidal rupture across papillomacular bundle.

PURPOSE: To report the visual result of Surgery for traumatic macular hole with choroidal rupture running across papillomacular bundle.
METHOD: Observation case report Patient 20 year old male patient presented with acute vison loss in OS with BCVA reduced to 20/80 following blunt trauma. Examination revealed full thickness macular hole with choroidal rupture between disc and macula, spanning across papillomacular bundle (PMB) in OS. Patient underwent 25G Vitreous Surgery with ILM peeling and SF6 injection for OS.
RESULTS: Macular hole was successfully closed at 4 weeks follow up and BCVA improved to 20/20. There was no postoperative complication.
CONCLUSION: We report that Traumatic macular holes with associated choroidal rupture running through PMB can be successfully repaired with Vitreous surgery and these eyes may achieve good visual outcome.

Introduction

Traumatic choroidal rupture has been associated with poor visual outcome with only about 20% of eyes regaining vision good enough to drive.[12] The common factors reported for poor visual outcome include choroidal rupture running at fovea and development of choroidal neovascularization.[1] Some studies have also reported good visual outcome in eyes with choroidal rupture, irrespective of location.[3] Although successful closure and good outcome following surgery have been reported for traumatic macular holes,[45] most surgeons regard the presence of an associated choroidal rupture running through papillomacular bundle (PMB) as a deterrent for recommending surgery for these patients.

We report the result of vitreous surgery in a 20-year-old male patient with traumatic macular hole with choroidal rupture running across PMB [Figure 1a] who presented 6 weeks after injury. On examination, his best-corrected visual acuity (BCVA) was 20/200 and optical coherence tomography (OCT) scan revealed full-thickness macular hole and choroidal rupture involving retinal pigment epithelium (RPE) under PMB [Figure 2a]. 25-G pars plana vitrectomy with internal limiting membrane peeling and SF6 gas injection were performed followed by face down positioning for 7 days. Macular hole was found to be closed at 4 weeks after surgery, and at 8-week follow-up [Figures 1b and 2b], BCVA improved to 20/20 in OS. There was no postoperative complication.

Figure 1

(a) Preoperative fundus picture showing choroidal rupture running across papillomacular bundle and full-thickness macular hole. (b) Postoperative fundus picture showing closed macular hole

Figure 2

(a and b) Preoperative and postoperative optical coherence tomography scans showing full-thickness macular hole closure following surgery and disrupted retinal pigment layer at the site of choroidal rupture (white arrow)

Comment

We report that traumatic macular holes with associated choroidal rupture running through PMB can be successfully repaired with vitreous surgery and these eyes may achieve good visual outcome. The excellent visual recovery in this case despite disrupted RPE in this case can be explained by intact nerve fiber layer as visible on preoperative OCT scans. The case report contradicts the conventional view that choroidal rupture through PMB might prevent good visual outcome in such cases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.