Fiorentzis Miltiadis, Seitz Berthold, Viestenz Arne
Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale).
Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg (Saar).
Klin Monbl Augenheilkd. 2019 Aug;236(8):990-998. doi: 10.1055/a-0608-4780. Epub 2018 Jul 13.
The traumatic macular hole (TMH) is a rare complication of a blunt or an open injury of the globe and can lead to permanent loss of vision. The pathomechanism of TMH differs from that of the idiopathic macular hole (IMH). A sudden compression and expansion of the globe leads to vitreous traction, which can result in a TMH. The final visual acuity depends on the severity of the disruption of the photoreceptors and the retinal pigment epithelial cells. The posttraumatic approach is discussed controversially. A spontaneous closure and, therefore, a conservative approach should be considered in young patients with minor defects and good visual acuity without detachment of the posterior vitreous body. In these cases, it is advisable to wait for months. In the absence of adhesion at the edges of the hole and concomitant pathologies of the pigment epithelium, the spontaneous closure is improbable. In this case, a pars plana vitrectomy with removal of the vitreous and epiretinal membranes can lead to anatomical reconstruction and improvement of the visual acuity. The success of an operative intervention is complex and is associated with the experience of the surgeon as well as the characteristics of the trauma.
外伤性黄斑裂孔（TMH）是眼球钝挫伤或开放性损伤的一种罕见并发症，可导致永久性视力丧失。TMH的发病机制与特发性黄斑裂孔（IMH）不同。眼球突然的压缩和扩张会导致玻璃体牵引，进而可能导致TMH。最终视力取决于光感受器和视网膜色素上皮细胞的破坏程度。创伤后的治疗方法存在争议。对于缺损较小、视力良好且无玻璃体后脱离的年轻患者，应考虑自发闭合，因此采取保守治疗方法。在这些情况下，建议等待数月。如果裂孔边缘没有粘连且色素上皮没有伴随病变，则自发闭合的可能性不大。在这种情况下，进行玻璃体切割术并去除玻璃体和视网膜前膜可实现解剖结构重建并提高视力。手术干预的成功与否较为复杂，与外科医生的经验以及创伤的特点有关。
