J Widmer-Pintos*, A Gómez-Benlloch, X Garrell-Salat, GJ Londoño-Rojas, C Arnaldos-López, S del-Pozo-Lérida, M Xirgu-Llach and L Sararols-Ramsay

Ophthalmology Department, Hospital General de Granollers, Barcelona, Spain

*Corresponding Author: J Widmer-Pintos, Ophthalmology Department, Hospital General de Granollers, Barcelona, Spain.

Received: August 04, 2023; Published: August 31, 2023

Abstract

This paper aims to emphasize the benefits of surgery combined with internal limiting membrane (ILM) inverted flaps and platelet concentrate in the treatment of large traumatic macular holes.

We report the particular case of a 37-year-old woman presenting a left-eye visual loss after receiving the impact of a billiard ball. Her best-corrected visual acuity (BCVA) was 0.8 (20/25) for her right eye and hand motion for her left eye. In the slit-lamp examination, no remarkable findings were observed in the anterior segment of both eyes. Intraocular pressure (IOP) was 15 mmHg in both eyes. On funduscopic exploration, a macular hole larger than 1 papillary diameter is observed in her left eye, without signs of retinal tears nor conmotio retinae. The posterior hyaloid was adhered and there was an associated choroidal rupture. The presence of a full thickness-macular hole was confirmed by optical coherence tomography (OCT), measuring 1900 µm in diameter.

Surgery was performed, consisting of a pars plana vitrectomy (PPV), the use of ILM inverted flaps to restore the macular anatomical structure, and the injection of platelet concentrate.

The patient showed an improvement in VA, which was 0.1 for her left eye. Three months after surgery, fibrosis adjacent to the macular hole and pigmentary changes around the macula could be observed. The choroidal rupture remains stable. On OCT, the macular hole seems more closed, with an area of minimal subretinal fluid inferior to the macula. The patient's BCVA remains stable.

The combined use of autologous plasma concentrate with the internal limiting membrane flap is advantageous because plasma concentrate holds the internal limiting membrane in the proper position and promotes the proliferation of glial cells through growth factors.

More studies need to be carried out to compare and confirm the benefits of using adjuvant treatments and complementary techniques in VA improvement.

 Keywords: Internal Limiting; Inverted Flap; Billiard Ball; Traumatic Macular Hole

References

1. Zhou Q., et al. “Vitrectomy vs. Spontaneous Closure for Traumatic Macular Hole: A Systematic Review and Meta-Analysis”. Frontiers in Medicine (Lausanne) 8 (2021): 735968.
2. Budoff G., et al. “Traumatic macular hole: diagnosis, natural history, and management”. Journal of Ophthalmology (2019): 2019.
3. Finn AP., et al. “Combined Internal Limiting Membrane Flap and Autologous Plasma Concentrate to Close a Large Traumatic Macular Hole in a Pediatric Patient”. Retinal Cases and Brief Reports 2 (2021): 107-109.
4. Caporossi T., et al. “Amniotic Membrane Plug to Promote Chronic Post-Traumatic Macular Hole Closure”. Ophthalmic Surgery, Lasers and Imaging Retina 1 (2019): 50-52.
5. Sánchez-Ávila RM., et al. “Plasma Rich in Growth Factors in Macular Hole Surgery”. Clinics and Practice1 (2022): 57-69.

Citation

Citation: J Widmer-Pintos., et al. “Internal Limiting Membrane Inverted Flap in Billiard Ball-Induced Traumatic Macular Hole".Acta Scientific Ophthalmology 6.9 (2023): 72-74.

Copyright

Copyright: © 2023 J Widmer-Pintos., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.