Characteristics and surgical outcomes of combat blast-related full-thickness traumatic macular holes: insights from war eye trauma in Ukraine

Abstract

This study analyzes the clinical features and surgical outcomes of combat blast-related traumatic full-thickness macular holes (BRTMH) secondary to war-related ocular trauma in Ukraine, managed at a single civilian center. Thirteen patients (14 eyes) with diagnosis of BRTMH treated with pars plana vitrectomy (PPV) were recruited for this retrospective, consecutive case, interventional study. Surgery outcome-related factors including face-down positioning were assessed and statistically analyzed. Blast trauma was the cause of injury in all (100%) of the MH cases, wearing no eye protection. Four eyes (28.6%) with MH were secondary to an open-globe, whereas ten eyes (71.4) were related to a closed-globe injury. MH closure was achieved in all cases (100%) after the primary surgery. The median (IQR) ocular trauma score (OTS) was 68 (56-75), while the time interval from injury to surgery was 41 (19 to 71) days. The median (IQR, interquartile range 25-75%) Minimum Linear Diameters of the MHs (µm) was 682 μm (532-889), while nine out of fourteen eyes (64.3%) had BRTMH > 600 μm. There was a direct correlation of postoperative visual acuity at 1 month with the OTS score (ρ = 0.51, p = 0.03) and preoperative visual acuity (LogMar) (ρ = 0.72, p = 0.002), and an inverse correlation with the size of the MH (ρ = -0.63 p = 0.008). Combination of different surgical approaches with minimization of postoperative face-down position time allows to achieve high anatomical and functional results being safe and highly acceptable for wounded patients with BRTMH.