Cui Ying, Wang Ge, Shi Xiangyu
Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, No.1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China.
BMC Ophthalmol. 2025 May 14;25(1):291. doi: 10.1186/s12886-025-04120-w.
Due to the small number of cases, limited knowledge exists on the surgical outcome of pediatric traumatic macular holes (MHs). This study aims to investigate the characteristics and surgical outcomes of pediatric traumatic MHs and analyse the associated factors of surgical outcomes.
59 pediatric patients that underwent vitrectomy for MHs caused by blunt trauma or laser pointer at a tertiary hospital were retrospectively recruited. Ophthalmic examination and optical coherence tomography were conducted at baseline and follow-ups.
The etiologies of the MHs were blunt trauma in 43 eyes and laser pointer in 16 eyes. The overall closure rate was 89.8%. MHs that did not close were larger than MHs that closed (P = 0.001). Among eyes with closed MHs, 41.5% achieved best corrected visual acuity (BCVA) of 20/40 or better (good responder). The good responders had better preoperative BCVA (P = 0.029), smaller minimal diameter (P < 0.001), and smaller preoperative ellipsoid zone defect (P = 0.002) than the poor responders (BCVA < 20/40). Patients hurt by blunt trauma were more likely to be poor responders than patients injured by laser pointer (P = 0.025, OR = 0.240, 95%CI: 0.066 ~ 0.866).
Pediatric MHs could be caused by blunt trauma or laser pointer. Vitrectomy was effective in closing the holes and improving visual acuity. The anatomic outcome was related with MH size. Worse preoperative BCVA, larger MH size and blunt trauma injury were predictors of poor functional outcome.
由于病例数量较少，关于儿童外伤性黄斑裂孔（MHs）的手术结果的知识有限。本研究旨在调查儿童外伤性MHs的特征和手术结果，并分析手术结果的相关因素。
回顾性招募了59例在三级医院因钝挫伤或激光笔导致MHs而接受玻璃体切除术的儿科患者。在基线和随访时进行眼科检查和光学相干断层扫描。
MHs的病因中，43眼为钝挫伤，16眼为激光笔伤。总体闭合率为89.8%。未闭合的MHs比闭合的MHs更大（P = 0.001）。在MHs闭合的眼中，41.5%的最佳矫正视力（BCVA）达到20/40或更好（良好反应者）。良好反应者术前BCVA更好（P = 0.029），最小直径更小（P < 0.001），术前椭圆体带缺损更小（P = 0.002），比反应差者（BCVA < 20/40）。钝挫伤患者比激光笔伤患者更有可能是反应差者（P = 0.025，OR = 0.240，95%CI：0.066～0.866）。
儿童MHs可由钝挫伤或激光笔引起。玻璃体切除术在闭合裂孔和提高视力方面是有效的。解剖学结果与MH大小有关。术前BCVA差、MH尺寸大以及钝挫伤是功能结果差的预测因素。
