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Pediatric Macular Hole

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A Quick Guide to Pediatric Retina

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Abstract

A macular hole is a full-thickness defect in the foveal neuroretinal tissue that can cause significant vision loss. While the majority of macular holes are “idiopathic” and age-related in nature, occurring as a result of a slow, degenerative process of progressive vitreoretinal traction, almost all macular holes encountered in the pediatric population are the result of direct ocular trauma. Owing to its disparate pathophysiology, the clinical course and prognosis of the pediatric traumatic macular hole is less predictable than that of idiopathic senile macular hole. Other traumatic ocular comorbidities may affect management and/or visual prognosis. Spontaneous closure may occur, and a period of observation is often undertaken, although considerations for deprivational amblyopia may prompt earlier intervention in younger patients. While surgical management is similar to that for idiopathic senile macular holes, the pediatric population poses unique surgical challenges including the adherent posterior hyaloid and limitations in the ability to position face-down postoperatively. This chapter provides an overview of pediatric traumatic macular holes, with attention to the key differences in epidemiology, anatomy, pathophysiology, diagnosis, and management in children, as compared to adults.

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References

  1. Noyes HD. Detachment of retina with laceration at macula. Trans Am Ophthalmol Soc. 1871;1(8):128–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Gass JD. Idiopathic senile macular hole. Its early stages and pathogenesis. Arch Ophthalmol. 1988;106(5):629–39.

    Article  CAS  Google Scholar 

  3. Johnson RN, Gass JD. Idiopathic macular holes. Observations, stages of formation, and implications for surgical intervention. Ophthalmology. 1988;95(7):917–24.

    Article  CAS  Google Scholar 

  4. Kuhn F, Morris R, Witherspoon CD, Mann L. Epidemiology of blinding trauma in the United States Eye Injury Registry. Ophthalmic Epidemiol. 2006;13(3):209–16.

    Article  Google Scholar 

  5. Yamashita T, Uemara A, Uchino E, Doi N, Ohba N. Spontaneous closure of traumatic macular hole. Am J Ophthalmol. 2002;133(2):230–5.

    Article  Google Scholar 

  6. Hirata A, Tanihara H. Ruptured internal limiting membrane associated with blunt trauma revealed by indocyanine green staining. Graefes Arch Clin Exp Ophthalmol. 2004;242(6):527–30.

    Article  Google Scholar 

  7. Johnson RN, McDonald HR, Lewis H, Grand MG, Murray TG, Mieler WF, et al. Traumatic macular hole: observations, pathogenesis, and results of vitrectomy surgery. Ophthalmology. 2001;108(5):853–7.

    Article  CAS  Google Scholar 

  8. Huang J, Liu X, Wu Z, Sadda S. Comparison of full-thickness traumatic macular holes and idiopathic macular holes by optical coherence tomography. Graefes Arch Clin Exp Ophthalmol. 2010;248(8):1071–5.

    Article  Google Scholar 

  9. Li XW, Lu N, Zhang L, Wang WW, Wang Y, Yan W, et al. Follow-up study of traumatic macular hole. Chin J Ophthalmol. 2008;44(9):786–9.

    CAS  Google Scholar 

  10. Miller JB, Yonekawa Y, Eliott D, Kim IK, Kim LA, Loewenstein JI, et al. Long-term follow-up and outcomes in traumatic macular holes. Am J Ophthalmol. 2015;160(6):1255–1258.e1251.

    Article  Google Scholar 

  11. Mitamura Y, Saito W, Ishida M, Yamamoto S, Takeuchi S. Spontaneous closure of traumatic macular hole. Retina. 2001;21(4):385–9.

    Article  CAS  Google Scholar 

  12. Gao M, Liu K, Lin Q, Liu H. Management modalities for traumatic macular hole: a systematic review and single-arm meta-analysis. Curr Eye Res. 2017;42(2):287–96.

    Article  Google Scholar 

  13. Chen H, Chen W, Zheng K, Peng K, Xia H, Zhu L. Prediction of spontaneous closure of traumatic macular hole with spectral domain optical coherence tomography. Sci Rep. 2015;5:12343.

    Article  Google Scholar 

  14. Williams GA. Macular holes: the latest in current management. Retina. 2006;26(6 Suppl):S9–12.

    PubMed  Google Scholar 

  15. Liu W, Grzybowski A. Current management of traumatic macular holes. J Ophthalmol. 2017;2017:1748135.

    PubMed  PubMed Central  Google Scholar 

  16. Spiteri Cornish K, Lois N, Scott N, Burr J, Cook J, Boachie C, et al. Vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with no peeling for idiopathic full-thickness macular hole (FTMH). Cochrane Database Syst Rev. 2013;(6):CD009306.

    Google Scholar 

  17. Park DW, Sipperley JO, Sneed SR, Dugel PU, Jacobsen J. Macular hole surgery with internal-limiting membrane peeling and intravitreous air. Ophthalmology. 1999;106(7):1392–7; discussion 1397-1398.

    Article  CAS  Google Scholar 

  18. Spiteri Cornish K, Lois N, Scott NW, Burr J, Cook J, Boachie C, et al. Vitrectomy with internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole. Ophthalmology. 2014;121(3):649–55.

    Article  Google Scholar 

  19. Enaida H, Hisatomi T, Hata Y, Ueno A, Goto Y, Yamada T, et al. Brilliant blue G selectively stains the internal limiting membrane/brilliant blue G-assisted membrane peeling. Retina. 2006;26(6):631–6.

    PubMed  Google Scholar 

  20. Kadonosono K, Itoh N, Uchio E, Nakamura S, Ohno S. Staining of internal limiting membrane in macular hole surgery. Arch Ophthalmol. 2000;118(8):1116–8.

    Article  CAS  Google Scholar 

  21. Kimura H, Kuroda S, Nagata M. Triamcinolone acetonide-assisted peeling of the internal limiting membrane. Am J Ophthalmol. 2004;137(1):172–3.

    Article  Google Scholar 

  22. Kuhn F, Morris R, Mester V, Witherspoon CD. Internal limiting membrane removal for traumatic macular holes. Ophthalmic Surg Lasers. 2001;32(4):308–15.

    CAS  PubMed  Google Scholar 

  23. Wachtlin J, Jandeck C, Potthofer S, Kellner U, Foerster MH. Long-term results following pars plana vitrectomy with platelet concentrate in pediatric patients with traumatic macular hole. Am J Ophthalmol. 2003;136(1):197–9.

    Article  Google Scholar 

  24. Abou Shousha MA. Inverted internal limiting membrane flap for large traumatic macular holes. Medicine. 2016;95(3):e2523.

    Article  Google Scholar 

  25. Eckardt C, Eckert T, Eckardt U, Porkert U, Gesser C. Macular hole surgery with air tamponade and optical coherence tomography-based duration of face-down positioning. Retina. 2008;28(8):1087–96.

    Article  Google Scholar 

  26. Essex RW, Kingston ZS, Moreno-Betancur M, Shadbolt B, Hunyor AP, Campbell WG, et al. The effect of postoperative face-down positioning and of long- versus short-acting gas in macular hole surgery: results of a registry-based study. Ophthalmology. 2016;123(5):1129–36.

    Article  Google Scholar 

  27. Hikichi T, Kosaka S, Takami K, Ariga H, Ohtsuka H, Higuchi M, et al. 23- and 20-gauge vitrectomy with air tamponade with combined phacoemulsification for idiopathic macular hole: a single-surgeon study. Am J Ophthalmol. 2011;152(1):114–121.e111.

    Article  Google Scholar 

  28. Hu Z, Xie P, Ding Y, Zheng X, Yuan D, Liu Q. Face-down or no face-down posturing following macular hole surgery: a meta-analysis. Acta Ophthalmol. 2016;94(4):326–33.

    Article  Google Scholar 

  29. Kim SS, Smiddy WE, Feuer WJ, Shi W. Outcomes of sulfur hexafluoride (SF6) versus perfluoropropane (C3F8) gas tamponade for macular hole surgery. Retina. 2008;28(10):1408–15.

    Article  Google Scholar 

  30. Modi A, Giridhar A, Gopalakrishnan M. Sulfurhexafluoride (SF6) versus perfluorfluoride (SF6) gas as tamponade in macular hole surgery. Retina. 2017;37(2):283–90.

    Article  CAS  Google Scholar 

  31. Nadal J, Delas B, Pinero A. Vitrectomy without face-down posturing for idiopathic macular holes. Retina. 2012;32(5):918–21.

    Article  Google Scholar 

  32. Wickens JC, Shah GK. Outcomes of macular hole surgery and shortened face down positioning. Retina. 2006;26(8):902–4.

    Article  Google Scholar 

  33. Garcia-Arumi J, Corcostegui B, Cavero L, Sararols L. The role of vitreoretinal surgery in the treatment of posttraumatic macular hole. Retina. 1997;17(5):372–7.

    Article  CAS  Google Scholar 

  34. Rubin JS, Glaser BM, Thompson JT, Sjaarda RN, Pappas SS, Murphy RP. Vitrectomy, fluid-gas exchange and transforming growth factor–beta-2 for the treatment of traumatic macular holes. Ophthalmology. 1995;102(12):1840–5.

    Article  CAS  Google Scholar 

  35. Uemura A, Nakamura M, Kachi S, Nishizawa Y, Asami T, Miyake Y, et al. Effect of plasmin on laminin and fibronectin during plasmin-assisted vitrectomy. Arch Ophthalmol. 2005;123(2):209–13.

    Article  CAS  Google Scholar 

  36. Margherio AR, Margherio RR, Hartzer M, Trese MT, Williams GA, Ferrone PJ. Plasmin enzyme-assisted vitrectomy in traumatic pediatric macular holes. Ophthalmology. 1998;105(9):1617–20.

    Article  CAS  Google Scholar 

  37. Chow DR, Williams GA, Trese MT, Margherio RR, Ruby AJ, Ferrone PJ. Successful closure of traumatic macular holes. Retina. 1999;19(5):405–9.

    Article  CAS  Google Scholar 

  38. Wu WC, Drenser KA, Trese MT, Williams GA, Capone A. Pediatric traumatic macular hole: results of autologous plasmin enzyme-assisted vitrectomy. Am J Ophthalmol. 2007;144(5):668–72.

    Article  Google Scholar 

  39. Drenser K, Girach A, Capone A Jr. A randomized, placebo-controlled study of intravitreal ocriplasmin in pediatric patients scheduled for vitrectomy. Retina. 2016;36(3):565–75.

    Article  CAS  Google Scholar 

  40. Hahn P, Chung MM, Flynn HW Jr, Huang SS, Kim JE, Mahmoud TH, et al. Safety profile of ocriplasmin for symptomatic vitreomacular adhesion: a comprehensive analysis of premarketing and postmarketing experiences. Retina. 2015;35(6):1128–34.

    Article  CAS  Google Scholar 

  41. Finn AP, Chen X, Viehland C, Izatt JA, Toth CA, Vajzovic L. Combined internal limitin gmembrane flap and autologous plasma membrane concentrate to close a large traumatic macular hole in a pediatric patient. Retinal Cases Brief Rep. 2018. e-print ahead of publication.

    Google Scholar 

  42. Kapoor KG, Khan AN, Tieu BC, Khurshid GS. Revisiting autologous platelets as an adjuvant in macular hole repair: chronic macular holes without prone positioning. Ophthalmic Surg Lasers Imaging. 2012;43(4):291–5.

    Article  Google Scholar 

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Acknowledgment

MPG is supported by an unrestricted departmental grant from Research to Prevent Blindness.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA

    Mrinali P. Gupta

  2. Long Island Vitreo-Retinal Consultants, Great Neck, NY, USA

    Philip J. Ferrone

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  1. Mrinali P. Gupta
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  2. Philip J. Ferrone
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Editor information

Editors and Affiliations

  1. Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

    Wei-Chi Wu

  2. Department of Ophthalmology, University of Hong Kong, Hong Kong, China

    Wai-Ching Lam

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Gupta, M.P., Ferrone, P.J. (2021). Pediatric Macular Hole. In: Wu, WC., Lam, WC. (eds) A Quick Guide to Pediatric Retina. Springer, Singapore. https://doi.org/10.1007/978-981-15-6552-6_31

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  • DOI: https://doi.org/10.1007/978-981-15-6552-6_31

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-6551-9

  • Online ISBN: 978-981-15-6552-6

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