Clinical characteristics and management outcomes of pediatric full-thickness macular holes

To report the etiologies, clinical course, and management outcomes of pediatric full-thickness macular holes (MH).

A retrospective observational case series.

Patients under the age of 18 years with confirmed full-thickness MH and a minimum of 3 months of follow-up, examined between January 1, 2025, and December 31, 2023, at a tertiary eye care center.

Data from all subjects were obtained from initial and follow-up visits, including demographic data, best-corrected visual acuity (BCVA), key examination and imaging findings, MH etiology, MH aperture, and base diameters based on optical coherence tomography (OCT) imaging (Spectralis; Heidelberg Engineering, Heidelberg, Germany), spontaneous closure rate, time to closure, surgical technique, surgical success rate for hole closure, postoperative complications, additional surgical procedures performed, and duration of follow-up.

Spontaneous closure rate versus surgical closure rate and BCVA at final follow-up.

Forty-seven eyes from 47 patients were included, the majority of which were Caucasian males. The mean age was 13 ± 3.17 years, and blunt trauma was the most common etiology (n = 41, 87%). The median MH aperture diameter was 222 μm (IQR 156, range: 110-565; n=25). Of those opting for watchful waiting, spontaneous closure was observed in 26 eyes (63%), and median closure time was 45 days from the date of initial diagnosis (IQR: 66.5, range: 8-302). Eighteen eyes (38%) underwent surgical intervention, on average 134 days (range: 4-553 days) from initial diagnosis. Of those undergoing surgery, MH closure was noted postoperatively in 13 eyes (72%). Two surgical complications (11%) were reported: a postoperative cataract that required subsequent extraction, and a reopening of MH within 1 year in a patient with X-linked retinoschisis (XLRS). For patients who underwent surgery, the mean BCVA improved from 20/315 (logMAR 1.20) at presentation to 20/70 (logMAR 0.54) at final follow-up (p < 0.05). For patients who underwent watchful waiting, the mean BCVA improved from 20/230 (logMAR 1.06) to 20/50 (logMAR 0.40) (p < 0.05). There was no statistically significant difference in BCVA at presentation or final follow-up between the surgical intervention group and the spontaneous closure group.

Macular holes in the pediatric population are most often the result of blunt trauma. Watchful waiting for spontaneous closure and surgical intervention both appear to have comparable outcomes on closure and vision recovery.