Incomplete closure of a traumatic macular hole after the use of autologous conditioned plasma: a case report

The treatment strategy for traumatic macular hole is poorly understood because of low incidence of this disorder. Notably, surgery results in incomplete closure of a traumatic macular hole in 16.67% of cases. To date, there is a lack of studies of a surgical failure, and there are no algorithms for further management of incomplete closure of a macular hole. This article describes a clinical case of traumatic macular hole after a closed-globe injury. Initial surgery, including pars plana subtotal vitrectomy, removal of the internal limiting membrane, application of autologous conditioned plasma, and air tamponade, resulted in incomplete closure of the macular hole. An analysis showed that the most likely causes of a surgical failure were delayed macular hole surgery (3 months after injury), initially large diameter of the macular hole (minimum diameter: 632 μm), large cystoid edema of the macular hole edges, and abnormal coagulation test results (fibrinogen: 1.61 g/L; prothrombin time: 14.3 s). Incomplete hole closure was repaired by repeated surgery with mechanical re-approximation of the macular hole edges, application of autologous conditioned plasma on the defect area, and silicone oil tamponade. This technique increased visual acuity from 0.05 to 0.4 and restored the macular anatomy.