Case Series: Anatomical and Functional outcomes after Lamellar Hole Surgery
Author: Mohamed El-Ashry (United Kingdom)
Co-authors: Thomas McNally, Chloe Thomas, Ibrar Ahmed, Panayiotis Maghsoudlou
Lamellar hole (LH) surgery remains controversial and evidence for long term outcomes is scarce. This study aimed to evaluate anatomical and functional outcomes after LH surgery with pars plans vitrectomy (PPV) in a local cohort of patients over a 12 month follow up period.
This study retrospectively reviewed the medical records of 41 patients who underwent PPV for LH between February 2015 and February 2020 in Great Western Hospital NHS Foundation Trust.
Baseline demographics included ocular and systemic co-morbidities, operation details and LH characteristics. Primary outcome was LH closure. All analyses were carried out using SPSS and GraphPad Prism.
Forty-seven eyes of 41 patients were operated on from 16th February 2015 to 18th February 2020. Seventy-three percent of patients (n=30) were diagnosed with tractional LH, compared to 27% (n=11) with degenerative LH. All patients underwent 23G PPV, 98% (n=40) of patients underwent internal limiting membrane (ILM) peel and 71% (n=29) underwent ERM peel. Mean LH volume and surface area were 0.126±0.118mm3 and 2.32±1.9mm2 respectively. In 93% (n=38) of patients anatomical resolution of the lamellar hole was achieved. In one patient the LH was still present and in one patient their LH progressed to a macular hole (MH). Two patients experienced complications post-operatively: one developed glaucoma and one required re-operation with PPV. Foveal thickness increased from 198±54μm pre-operatively to 324±77μm at 1 month post-operatively (P<0.0005) and then decreased to 312±81μm at 3 months (P<0.0005) and 296±62μm at 12 months (P<0.0005). Binary logistic regression did not demonstrate any predictors for LH closure. Multiple linear regression analysis (Rsq = 0.6126) with 9 anatomical variables at baseline significantly predicted the foveal thickness at last follow-up (P<0.001).
PPV is a safe treatment for LH and is effective in terms of anatomical outcomes with a low risk of complication. Measurement of anatomical variables at baseline can accurately predict the final outcome.
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