title: Management Modalities for Traumatic Macular Hole: A Systematic Review and Single-Arm Meta-Analysis.
abstract: The purposes of this study were to (i) determine macular hole (MH) closure rates and visual outcomes by comparing two methods of managing traumatic MH (TMH)-an event resulting in severe loss of visual acuity (VA); (ii) characterize patients who undergo spontaneous TMH closure; (iii) determine which TMH patients should be observed before resorting to surgical repair; and (iv) elucidate factors that influence postoperative visual outcomes.
  
  
  
  Studies (n=10) of patients who were managed by surgery or observation for TMH were meta-analyzed retrospectively. Management modalities included surgical repair (surgery group) and observation for spontaneous hole closure (observation group). In addition, a 12-case series of articles (1990-2014) on spontaneous hole closure was statistically summarized. SAS and Comprehensive Meta-Analysis (CMA) (version 3.0) were used for analysis.
  
  
  
  For surgery group patients, the fixed-model pooled event rate for hole closure was 0.919 (range, 0.861-0.954) and for observation group patients, 0.368 (range, 0.236-0.448). The random-model pooled event rate for improvement of visual acuity (VA) for surgery group patients was 0.748 (range, 0.610-0.849) and for observation group patients, 0.505 (range, 0.397-0.613). For patients in both groups, the mean age of spontaneous closure was 18.71±10.64 years; mean size of TMHs, 0.18±0.06 decimal degrees (DD); and mean time for hole closure, 3.38±3.08 months. The pooled event rate for visual improvement was 0.748 (0.610-0.849).
  
  
  
  Hole closure and VA improvement rates of surgery group patients were significantly higher than those for observation group patients. Patients of ≤ 24 years of age with MH sizes of ≤ 0.2DD were more likely to achieve spontaneous hole closure. The interval of time from injury to surgery was statistically significantly associated with the level of visual improvement.
authors.affiliation: a Department of Ophthalmology , Shanghai General Hospital, Shanghai JiaoTong University School of Medicine , Shanghai , People's Republic of China.
authors.forename: Min
authors.initials: M
authors.lastname: Gao
authors.affiliation: a Department of Ophthalmology , Shanghai General Hospital, Shanghai JiaoTong University School of Medicine , Shanghai , People's Republic of China.
authors.forename: Kun
authors.initials: K
authors.lastname: Liu
authors.affiliation: a Department of Ophthalmology , Shanghai General Hospital, Shanghai JiaoTong University School of Medicine , Shanghai , People's Republic of China.
authors.forename: Qiurong
authors.initials: Q
authors.lastname: Lin
authors.affiliation: a Department of Ophthalmology , Shanghai General Hospital, Shanghai JiaoTong University School of Medicine , Shanghai , People's Republic of China.
authors.forename: Haiyun
authors.initials: H
authors.lastname: Liu
mesh_terms: D019468:Disease Management; D005131:Eye Injuries / Q000150:complications / Q000601:surgery*; D006801:Humans; D012075:Remission, Spontaneous; D012167:Retinal Perforations / Q000209:etiology / Q000601:surgery*; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
keywords: Single-arm meta-analysis; TMH; spontaneous closure; traumatic MH; treatment; vitrectomy