Traumatic Maculopathy with Massive Subretinal Hemorrhage after Closed-Globe Injuries: Associated Findings, Management, and Visual Outcomes

Purpose: To investigate the visual outcomes of patients with traumatic maculopathy and massive subretinal hemorrhage (SRH) after closed-globe injury. Design: Retrospective, noncomparative, and interventional case series. Participants: Twenty-four patients with traumatic maculopathy and massive SRH after closed-globe injury. Methods: In this retrospective observational case series, we included 25 eyes of 24 patients who had experienced closed-globe injury with massive SRH. Main Outcome Measures: The demographics, clinical characteristics, and final visual acuity (VA) of the patients. Results: Twenty-five eyes with massive SRHs involving the macula were studied with initial VAs from light perception to 4/200. At initial presentation, vitreous hemorrhages were present in 22 eyes, hyphema in 13 eyes, lid lacerations in 11 eyes, glaucoma in 8 eyes, iridodialysis in 7 eyes, afferent pupillary defect in 6 eyes, lens dislocation or subluxation in 5 eyes, and cyclodialysis clefts and hypotony in 2 eyes. Retinal detachment developed in 7 eyes during the follow-up period. Pars plana vitrectomy usually was performed in patients with persistent vitreous hemorrhage, retinal detachment, lens dislocation, and cyclodialysis cleft with hypotony. In final visual outcomes, 7 eyes achieved favorable visual outcomes with VA of 20/200 or more. Thirteen eyes showed VA of 2/200 or less with dense macular scars or foveal atrophy. Foveal atrophy showed encompassed foveal thinning, retinal pigment epithelial clumping, and the loss of external limiting membrane (ELM), ellipsoidal zone (EZ), and interdigital zone (IZ) on spectral-domain OCT. Fundus autofluorescence demonstrated interposed, reduced, and increased autofluorescence in traumatic pigment epitheliopathy. Conclusions: Traumatic maculopathy and massive SRH after closed-globe injury often cause poor visual outcomes, especially in eyes with dense macular scars or foveal atrophy. Spectral-domain OCT findings in patients with good visual outcomes revealed partial to complete preservation of the foveal ELM, EZ, and IZ.