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

Background: 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. Methods: 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. Results: 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). Conclusion: 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.