Vitrectomy and internal limiting membrane peeling of a traumatic macular hole with retinal folds

An 8-year-old active boy suffered a penetrating injury to his right eye. A temporal retinal perforation with an adherent blood clot about 4-disc diameter from the fovea was noted. Six weeks after the initial primary repair, a macular hole (MH) and retinal folds radiating from the penetrating site of the retina were found. Two months after the injury, the patient underwent a standard pars plana vitrectomy. Intraoperatively, the retinal folds still existed after creating a posterior hyaloid detachment and disappeared concurrently within the area of the internal limiting membrane peeling. Occlusion therapy was carried out after absorption of the intraocular gas. One year after the vitrectomy surgery, the MH remained closed with a visual acuity improving from 20/60 to 20/25 in his right eye. Our results suggest that vitrectomy with internal limiting membrane peeling and sequential occlusion therapy can achieve both anatomical and functional improvement in a child suffering a penetrating injury with a MH and retinal folds.