Trou maculaire post-traumatique : caractéristiques, mécanismes, traitement chirurgical et récupération fonctionnelle. - 08/03/08
S Bonnel,
C (Paris) Monin,
N (Beyrouth, Liban) Macaron,
C Morel,
M Abitbol,
L (Paris) Larochel
Purpose. To explain the specific clinical characteristics, pathogenic mechanisms and post-operative visual outcomes of surgical treatment in a series of patients with traumatic macular holes.
Matériel et Méthode : We retrospectively reviewed 15 eyes that had been treated by two vitreoretinal surgeons. Trans pars plana vitrectomy was used to create posterior vitreous detachment and autologous serum instillation followed by retinal tamponade with 18% C2F6 gas. The patients were kept in the prone position for 14 days.
Résults. The macular holes appeared either just after the accident, within one month of the accident or over one year after the accident. The macular holes were successfully closed in 13 (86.7%) cases. The mean best-corrected preoperative visual acuity was 20/200, and postoperative visual acuity was 20/60 with a mean follow-up of 20.2 months. A mean improvement of 3.1 lines was obtained.
Conclusions. Vitreous surgery can lead to anatomic success and the improvement of visual acuity. The pathogenic mechanisms seem to differ according to the delay between the injury and the appearance of the hole. Macular holes appeared immediately after the contusion due to acute vitreo-retinal traction induced by the initial traumatism. Secondary traumatic macular holes formation resulted from posterior vitreous detachment with or without Berlin's edema.
© 2002 Elsevier Masson SAS. Tous droits réservés.
Vol 25 - N° 5
P. 28 - avril 2002 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.