Pediatric macular holes (MH) have their own less well-known particularities in terms of etiology, clinical features and prognosis compared with adult forms. A recent study retrospectively analyzed data from a case series of pediatric patients with MH and found trauma was the most prevalent predisposing factor. The researchers also found that spontaneous closure is more likely to occur in traumatic MH with smaller diameters with an average time of two months.

The review included data from a cohort of 40 eyes of 40 Chinese patients younger than 16 years old with a full-thickness MH. Patients were predominantly male with a mean age of 8.3 years. While pediatric MH can be derived from a wide variety of primary ocular conditions, blunt trauma was the cause in 72.5% of eyes.

The study noted that 29 patients, of whom 18 had traumatic MH, underwent surgery and all achieved hole closure. The researchers documented spontaneous closure in 10 eyes after an average of two months post-trauma, suggesting watchful waiting may be an option for patients with decreased macular hole diameter and resolution of retinal detachment.

Considering the risk of amblyopia due to reduced visual acuity caused by a macular hole, they only recommend conservative management for a short amount of time. Nevertheless, the study notes that the presence of macular lesions was a risk factor for final poor vision, regardless of surgery or spontaneous closure.

The researchers concluded that visual function improved significantly after the MH was sealed, whether with surgery or spontaneous closure. When necessary, surgery is an effective treatment for pediatric MHs and has a high success rate.

Liu J, Peng J, Zhang Q, et al. Etiologies, characteristics and management of pediatric macular hole. Am J Ophthalmol. September 24, 2019. [Epub ahead of print].