Visual prognostic indicators in traumatic macular hole surgery SGN Presenter: Dr .Rashmi Amarnath Drs. K.S. Sriprakash, H.V.Chandrakumar REGIONAL INSTITUTE OF OPHTHALMOLOGY MINTO OPHTHALMIC HOSPITAL

Traumatic macular holes First described by Herman Knapp in 1869 Traumatic macular hole is a well recognized complication of ocular trauma Can occur as a result of contre coup injury – retinal dehiscence/ as a result of breakdown of traumatically induced cystoid change Usually associated with other features of trauma- retinal detachment, vitreous haemorrhage

Though improved success rate in noted in IMH, and is found to depend on duration, size, the prognostic indicators in traumatic holes have not been established clearly

Aim To determine the factors which influence the post operative visual acuity in patients undergoing traumatic macular hole surgery

Materials and methods 8 consecutive patients (8 eyes) with traumatic macular holes who presented at Retina clinic , Minto Eye Hospital , Bangalore and underwent macular hole surgery between April 2002 to Oct 2003 were included in the study.

Preoperative and post operative assessment PRE- OP POST-OP1d, 1w, 4w, 6m, 1y BCVa Refraction IDO Slit lamp biomicroscopy Fundus photography Ultrasonography FFA Fields/Amsler’s grid

The size of the hole was individually assessed with respect to the disc

Patients with isolated macular hole underwent pars plana vitrectomy with air-fluid exchange with injection of 20%SF6 PVD was induced in patients without PVD Patients maintained face down position for 1 weeks

Patients with associated retinal detachment underwent pars plana vitrectomy + treatment for peripheral breaks with membrane peeling + with air fluid exchange with silicone oil injection Patients maintained face down positioning for 2 weeks 1 patient required lensectomy due to traumatic cataract

RESULTS

ANALYSIS

Cause of trauma Injury No of cases Stick 4 Stone 2 Injury by fist 1 Shuttle cock

Age / sex distribution

Symptoms- Diminution of vision- sudden, gradual Central visual field defect- 3 patients Duration of symptoms- 15days- 1 year

Duration between trauma & onset of symptoms

Duration between onset of symptoms & presentation

Correlating injury, symptoms and presentation

Associated features at presentation Isolated TMH 1 TMH+ VH TMH+ Macular edema +subhyaloid hhg TMH+ Sub retinal fluid Rheg RD with peripheral holes (3 single+ I multiple breaks) 4

Visual acuity at presentation Findings Va Isolated TMH 6/36 or better TMH+ VH/ Mac edema 6/240 -6/36 TMH+RD PL+-6/240

Pre op visual acuity Post op visual acuity 1 6/36 6/24 2 6/240 3 4 6/60 6/2400 5 6 6/1200 7 6/800 8 PL+

Visual acuity results

Visual acuity and duration Improved Maintained Deteriorated <1m 1 1m-6m 2 6m-1year >1year

Size of macular hole

Visual acuity and size of hole

Associated PVD

Correlating post-op visual acuity with PVD

Post operative complications Retinal detachment in 1 patient with retinal dialysis Silicone oil induced glaucoma in 1 patient

All 3 patients reported subjective improvement in size of central scotoma.

Conclusions Improvement in visual acuity in a significant number of patients undergoing surgery. Size of macular hole did not determine visual improvement Duration of macular hole did not determine the final visual acuity

Significant improvement in visual acuity of patients who did not have PVD Patients without retinal detachment or vitreous haemorrhage presented late but with better visual acuity 6. Subjective improvement in the size of central scotoma

VIDEO

VIDEO

THANK YOU Acknowledgements: Staff of retina clinic All the patients