We thank Venkatesh and associates kindly for this correspondence. Venkatesh and associates mention the 2 mechanisms proposed by Yashimata and associates involving immediate or delayed foveal dehiscence in the creation of traumatic macular hole. They suggest that we further analyze our vitrectomy cases with and without internal limiting membrane (ILM) peeling to better understand the ILM’s role in traumatic macular hole. We did actually examine the effect of ILM peeling on outcomes. As stated in the second paragraph of page 1257, 7 of 11 patients had ILM peeling at the time of repair. There was no statistically significant difference in hole closure rates with or without ILM peeling.
Venkatesh and associates also mention 1 case report by Lewis and associates with resolution of a macular hole associated with the development of an epiretinal membrane (ERM). Based on this singular report they claim that one of the mechanisms of spontaneous closure of traumatic macular holes is the appearance of an ERM. However, that 1 reported occurrence does not imply that all ERMs aid in a spontaneous closure, nor that spontaneous closure requires the presence of an ERM. Venkatesh and associates suggest that our data describing epiretinal membrane peeling in 10 of 11 surgical cases further imply that the presence of an ERM reduces the chances of hole closure. We believe that they are over-interpreting the results, since we did not specifically look at the presence or absence of epiretinal membrane in our clinical examination data, nor did we have preoperative optical coherence tomography in all surgical cases.
Venkatesh and associates also mention that associated morbidities affect the vision and should have been discussed further. We agree that comorbidities are important, and on page 1256, in the first paragraph of the results section, we mention, “At presentation, 2 (7.1%) had open globe injuries, 17 (57.1%) had hyphema, 13 (46.4%) had vitreous hemorrhage, 1 (3.6%) had a posterior vitreous detachment (PVD), and 10 (38.5%; 10 of 26 with a view and records) had foveal commotio. Three patients had choroidal rupture, with only 1 involving the hole.” We believe that of these factors, foveal commotio might have been the most likely to have an influence on final visual acuity, but our analysis did not demonstrate a statistically significant correlation.