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Etiologies, Characteristics, and Management of Pediatric Macular Hole
Jingjing Liu1, Jie Peng1, Qi Zhang1
1Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Pediatric macular holes (MH) are often caused by trauma. Smaller traumatic MHs may close spontaneously within 2 months, and visual acuity improves post-closure. Macular lesions indicate a risk for poor vision.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Pediatric Eye Care
Background:
- Macular holes (MH) in children are uncommon.
- Understanding the causes and outcomes of pediatric MH is crucial for effective management.
Purpose of the Study:
- To investigate the etiologies and prognosis of macular holes (MH) in pediatric patients.
- To identify predictors for spontaneous MH closure and poor final visual outcomes (vision worse than 20/200).
Main Methods:
- Retrospective case series of 40 pediatric patients (<16 years) with full-thickness MH from 2013-2019.
- Data included demographics, best-corrected visual acuity (BCVA), MH etiology and size, and outcomes.
- Logistic regression analyzed factors influencing spontaneous closure and final vision.
Main Results:
- Trauma was the primary cause (72.5%) of pediatric MH.
- All patients achieved hole closure, with improved BCVA post-closure.
- Smaller MH size predicted spontaneous closure (P=.006), occurring in 25% of cases within 2 months.
- Macular lesions were a significant risk factor for poor final vision (P=.001).
Conclusions:
- Blunt trauma is the leading cause of pediatric macular holes.
- Visual acuity improves after MH closure, irrespective of treatment modality.
- Early identification of smaller traumatic MHs and associated macular lesions can guide prognosis and management.
Purpose:
To report on the etiologies and prognosis of macular hole (MH) in children and to explore the indicators of spontaneous hole closure and poor final visual outcome (vision worse than 20/200).
Design:
Consecutive, retrospective case series.
Methods:
A consecutive series of patients aged less than 16 years with a full-thickness macular hole treated from 2013 to 2019 in a singer tertiary center was retrospectively reviewed. Data collected from charts included age, sex, best-corrected visual acuity (BCVA), etiology of MH, size of MH, clinical findings, operations, and anatomic and functional outcomes. Logistic regression models were built to establish the predisposing factors.
Results:
Forty eyes of 40 patients were included. Patients were predominantly male with a mean age of 8.3 years. Among the etiologies, trauma prevailed in 29 (72.5%) eyes. Twenty-nine patients underwent surgery, and 18 (62.1%) had traumatic MH. All had achieved hole closure. BCVA improved at the final visit. Spontaneous closure was found in 10 (25%) eyes after an average 2 months after trauma. Regression analysis showed that a relatively smaller macular hole (P = .006) was likely to experience spontaneous closure. Presence of macular lesions (P = .001) was identified as risk factor for poor final vision.
Conclusions:
Most pediatric MH was caused by blunt trauma. BCVA improved after MH closed, regardless of surgery or spontaneous closure. Smaller MH secondary to trauma was more likely to experience spontaneous closure with an average time of 2 months. Presence of macular lesions was a risk factor for final poor vision.
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