Traumatic macular holes secondary to combat ocular trauma

This study reports on the visual impact of combat related traumatic macular hole formation at a single tertiary referral center.

Retrospective, noncomparative, interventional consecutive case series.

Seventeen of 432 consecutive traumatic macular holes occurred in 387 United States soldiers during Operations Iraqi and Enduring Freedom between March 2003 and October 2006. The median age was 28 +/- 9 years (range, 19-49 years) and the median follow-up was 292 +/- 453 days (range, 59-1640 days). Closed-globe macular holes equaled 11 of 234 cases (5%), and open-globe macular holes were 6 of 198 (3%). Traumatic macular hole was associated with a retinal detachment in 8 of 17 cases (47%). The overall documented macular hole closure rate was 9 of 15 cases (60%). There was no statistical difference in hole closure rates between surgery and observation (P = 0.34). Severe nonocular injuries occurred in 12 of 17 (71%), with the median time to macular hole surgical repair of 18 +/- 37 days (range, 7-132). There was a significant positive association between the Ocular Trauma Score equal to or greater than 80 and a best-corrected visual acuity of 20/200 or greater (r = 0.87, n = 15; P < 0.005).

Traumatic macular hole occurs in both open and closed globe combat trauma with high rates of nonocular injuries. Visual outcome is highly variable despite macular hole closure in a majority of patients due to concomitant globe injuries. The Ocular Trauma Score is useful in predicting final visual acuity and traumatic macular hole closure.