Traumatic macular holes secondary to combat ocular trauma

Purpose: This study reports on the visual impact of combat related traumatic macular hole formation at a single tertiary referral center. METHODS: Retrospective, noncomparative, interventional consecutive case series. RESULTS: 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). CONCLUSION: 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.