Combat high-intensity light-induced full-thickness macular hole: A case report

This case report aims to present a unique case of high-intensity light-induced full-thickness macular hole in a soldier, which was managed with vitrectomy and internal limiting membrane (ILM) double flap.

A patient presented with decreased visual acuity and central scotoma after gazing at the spotlight of the air defense system. Both ophthalmoscopy and optical coherence tomography (OCT) were used to visualize the macula and diagnose the macular hole. The best-corrected visual acuity (BCVA) at admission to the clinic was 0.12 (20/160) eccentric. The full-thickness macular hole measured 534 μm in diameter on OCT. The patient was treated using 25-G vitrectomy with ILM double flap and intraocular gas (15% perfluoropropane) tamponade, followed by postoperative head-down positioning. The surgery successfully achieved macular hole closure with partial restoration of photoreceptors on OCT. The postoperative BCVA was 0.25 (20/80) at 1 month.

Therefore, although rarely observed, high-intensity light can cause full-thickness macular hole among soldiers, which can be successfully managed with vitrectomy and ILM double flap. Wearing protective equipment during potential light exposure by military personnel is mandatory to prevent such injuries.