Management Modalities for Traumatic Macular Hole: A Systematic Review and Single-Arm Meta-Analysis

Abstract

<p><i>Purposes</i>: The purposes of this study were to (i) determine macular hole (MH) closure rates and visual outcomes by comparing two methods of managing traumatic MH (TMH)—an event resulting in severe loss of visual acuity (VA); (ii) characterize patients who undergo spontaneous TMH closure; (iii) determine which TMH patients should be observed before resorting to surgical repair; and (iv) elucidate factors that influence postoperative visual outcomes.</p> <p><i>Methods</i>: Studies (n=10) of patients who were managed by surgery or observation for TMH were meta-analyzed retrospectively. Management modalities included <i>surgical repair</i> (surgery group) and <i>observation</i> for spontaneous hole closure (observation group). In addition, a 12-case series of articles (1990–2014) on spontaneous hole closure was statistically summarized. SAS and Comprehensive Meta-Analysis (CMA) (version 3.0) were used for analysis.</p> <p><i>Results</i>: For surgery group patients, the fixed-model pooled event rate for hole closure was 0.919 (range, 0.861–0.954) and for observation group patients, 0.368 (range, 0.236–0.448). The random-model pooled event rate for improvement of visual acuity (VA) for surgery group patients was 0.748 (range, 0.610–0.849) and for observation group patients, 0.505 (range, 0.397–0.613). For patients in both groups, the mean age of spontaneous closure was 18.71±10.64 years; mean size of TMHs, 0.18±0.06 decimal degrees (DD); and mean time for hole closure, 3.38±3.08 months. The pooled event rate for visual improvement was 0.748 (0.610–0.849).</p> <p><i>Conclusions</i>: Hole closure and VA improvement rates of surgery group patients were significantly higher than those for observation group patients. Patients of ≤ 24 years of age with MH sizes of ≤ 0.2DD were more likely to achieve spontaneous hole closure. The interval of time from injury to surgery was statistically significantly associated with the level of visual improvement.</p