Macular massaging in traumatic pediatric macular holes: A case series

Exploring macular massage in traumatic macular holes in pediatric population with a novel technique of using ILP flap as a scaffold. Three patients with traumatic pediatric macular holes underwent macular massage as a primary treatment at our institution between 2023 to 2024. Age ranged from 9 to 13 years. All patients had a history of ocular trauma, with the time from injury to presentation ranging from 6-8 months. The same macular massage technique was used in all the cases by the same surgeon. Massage was applied across 360° (all clock hours) within a 3 disc diameter (DD) radius of the hole edge using 10–15 gentle strokes with the TANOS duster and ILM peeled as a scaffold. The peeled ILM tissue was used as a scaffold under a TANOS diamond duster to reduce inadvertent trauma to retinal tissue. Pressure was titrated to visible retinal mobility without vessel displacement. The ending point where the lip of the macular hole is apposed is noted. SF6 tamponade was used. Postoperative prone positioning was encouraged for 1 week. Type 1 macular hole closure in all patients with postoperative 3-month visual acuity ranging from 20/20 to 20/80. The existing literature on the management of traumatic pediatric macular holes is limited; this is the first study where macular massage was employed for post-traumatic chronic macular holes in the pediatric population. In our cases, we highlight that the macular massaging technique, especially in post-traumatic scenarios where additional elements of chorioretinal scarring and poor retinal elasticity are present, provided excellent outcomes. The present case series represents an important addition to the existing knowledge on the management of traumatic pediatric macular holes and adds to the growing body of evidence supporting the use of macular massage as a viable treatment option.