Causes and symptoms of traumatic macular hole

Traumatic macular holes can be said to be the earliest known cause of macular holes. Young men are particularly susceptible to this disease, and clinically, there are symptoms such as black shadows floating in front of the eyes, decreased vision, and flashes of light.

1 Classification of macular cleavage

A macular hole is a full-thickness tissue loss of the retinal neuroepithelium in the macula. Macular holes are divided into three categories: idiopathic macular holes, secondary macular holes and traumatic macular holes. The following is an explanation of traumatic macular hole. Traumatic macular hole (TMH) Trauma was the earliest known cause of macular hole, and it is most common in young males.

2 Etiology and pathogenesis

Traumatic macular holes are retinal holes in the fovea caused by blunt trauma to the eye. The exact pathogenesis of traumatic macular holes remains controversial. Some scholars believe that the fissure occurs immediately after the injury, some believe that it is formed after a period of time, and others believe that both situations may exist. The mechanism of traumatic macular hole is mainly that the eyeball is suddenly impacted by external force, which causes the ball to deform instantly, compress the anterior-posterior diameter, and expand toward the equator, resulting in traction on the interface between the vitreous body and the retina. The fovea tissue, one of the tight attachment points between the vitreous body and the retina, is instantly torn and then gradually expands into a circle.

3 Clinical characteristics

Sparkling feeling. A dark shadow was floating before my eyes. Decreased vision. Fundus examination: A round or oval hole with sharp edges can be seen in the macular area. The sizes of the holes vary, ranging from 1PD to the size of a pinpoint, and are generally 1/2 to 1/4PD. The base of the hiatus is dark red (the color of the deep choroidal vessels). Visual field examination: A central or paracentral dark spot corresponding to the macular hole can be found. Visual field damage is more common in 2 to 3 degrees, and less common above 5 degrees. There is no damage to the peripheral visual field. Fundus fluorescein angiography (FFA): Full-thickness macular holes appear as fluorescent translucency, outer lamellar holes appear as window-like defects of varying degrees, inner lamellar holes appear as weak translucency, and if they are close to full-thickness holes, they appear as window-like defects. Optical coherence tomography (OCT): The OCT image of a full-thickness macular hole shows a full-thickness loss of the retinal neuroepithelium in the macular area deep into the pigment epithelium, with clear edges of the hole and surrounding retinal thickening. There may or may not be fluid accumulation under the retina, with or without posterior vitreous detachment, and sometimes traction of the posterior vitreous limiting membrane on the macula can be seen. Lamellar holes are manifested by a steepening of the foveal shape and partial loss of the neuroepithelium. In addition, patients with traumatic macular holes often have changes such as serous detachment of the neuroepithelium, hemorrhagic pigment epithelial detachment, edema between the neuroepithelial layers, formation of proliferative membranes in the macular area, retinal macular hemorrhage, and thinning of the neuroepithelial layer in the macular area.