Vitrectomy vs. Spontaneous Closure for Traumatic Macular Hole: A Systematic Review and Meta-Analysis

Abstract

Objective: This systematic review and meta-analysis aimed to determine the traumatic macular hole (TMH) closure rate and visual acuity (VA) improvement rate by comparing two treatment methods for TMH: vitrectomy and observation for spontaneous closure.Methods: PubMed, Cochrane, Web of Science Library, Embase, CNKI, Wanfang, VIP, and Sino Med were systematically searched from their inception to June 10, 2021. Studies in the surgery group (n = 32) and studies in the observation group (n = 12) were meta-analyzed. The primary outcomes were the TMH closure and VA improvement rates in the surgery and observation groups. The secondary outcomes were best-corrected visual acuity (BCVA) improvement in the surgery group. Stata software (version 15.1) was used for the analyses.Results: Thirty-six studies that included 1,009 eyes were selected for this meta-analysis, among which 33 were retrospective studies and 3 were prospective studies. The meta-analysis showed that the random-model pooled event rate for TMH closure was 0.37 (95% confidence interval [CI], 0.26–0.48) in the observation group, while it was 0.9 (95% CI, 0.85–0.94) in the surgery group. The fixed-model pooled event rate for VA improvement was 0.39 (95% CI, 0.33–0.45) in the observation group, while the random-model pooled event rate of VA improvement for the surgery group was 0.72 (95% CI, 0.63–0.80). The pooled event rate for BCVA improvement in the surgery group was 0.39 (95% CI, 0.33–0.46).Conclusions: This meta-analysis suggests that TMH hole closure and VA improvement rates in the surgery group were significantly higher than those in the observation group. Vitrectomy is an effective method for treating TMH. However, further randomized controlled trials (RCTs) are required to evaluate the efficacy and safety of surgery and observation for TMH treatment.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier: CRD42021276684.

Eccentric Fixation and Good Visual Acuity in a Child with Large Traumatic Macular Hole: A Case Report

“…Common in these approaches, the first step is observation for 3 months, as spontaneous closure is possible. Surgical intervention is typically recommended if a TMH does not resolve spontaneously within 3 months, according to some studies [ 2 , 9 , 10 ].…”

“…The high rate of spontaneous closure may be attributable to the fact that TMH patients are young and have a healthy vitreous gel and vitreoretinal attachment. Indeed, young age, small hole size, cystic edema at the border of the MH, and the absence of posterior vitreous detachment have been identified as factors that may accelerate spontaneous closure [ 9 ].…”

Pediatric Traumatic Macular Hole—A Review

“…A recent metanalysis from 2021 48 investigated the closure rates and VA improvement by comparing vitrectomy and observation in patients with TMHs. The study included 12 observational studies and 32 studies where vitrectomy was performed to treat TMHs.…”