1. 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

2. 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

3. 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

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

5. 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.

6. 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

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

8. 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

9. 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

10. RESULTS

11. ANALYSIS

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

13. Age / sex distribution

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

15. Duration between trauma & onset of symptoms

16. Duration between onset of symptoms & presentation

17. Correlating injury, symptoms and presentation

18. 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

19. 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

20. 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+

21. Visual acuity results

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

23. Size of macular hole

24. Visual acuity and size of hole

25. Associated PVD

26. Correlating post-op visual acuity with PVD

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

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

29. 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

30. 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

31. VIDEO

32. VIDEO

33. THANK YOU
Acknowledgements:
Staff of retina clinic
All the patients