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Natural history and surgical outcomes of lamellar macular holes

Author: Ismael Chehaibou (France)

Co-authors: Ramin Tadayoni, Jean Pierre Hubschman, David Steel

Purpose

To assess the natural history, and the surgical outcomes of lamellar macular holes (LMH).

Setting/Venue

Clinical charts and optical coherence tomography features of patients with LMH from multiple tertiary care centers were reviewed in this retrospective study.

Methods

The natural history of eyes that were observed, and the functional and anatomical outcomes of eyes that underwent surgery were analyzed. Within the operated group, surgical outcomes were compared between eyes that had epiretinal proliferation (ERP) peeled off from the surface of the retina with those that had peeling surrounding the foveal center with preservation of the central ERP (referred to as ERP perihole peeling).

Results

178 eyes were included, of which 89 underwent surgery and 89 were monitored. In the observation group, the mean visual acuity (VA) decreased from 0.25 +/- 0.18 to 0.28 +/- 0.18 logMAR (20/35 to 20/38 Snellen equivalent) (P = 0.079) over 45.7 +/- 33.5 months of follow-up. Nine eyes (10.1%) spontaneously developed a full-thickness macular hole. In the operated group, the mean VA increased from 0.47 +/- 0.23 to 0.36 +/- 0.28 logMAR (20/59 to 20/45 SE) (P = 0.0001) after a mean follow-up of 21.5 +/- 28.6 months. ERP was peeled off in 65 eyes (73.0%) while 24 eyes (27.0%) had ERP peri-hole peeling. Mean visual acuity gain was significantly greater in eyes that had ERP peri-hole peeling (-0.22 +/- 0.20 logMAR) compared to those that had proliferation peeled off (-0.07 +/- 0.30 logMAR) (P = 0.013). Eight eyes (8.5%) developed a postoperative full-thickness macular hole, of which all but one had proliferation peeled off.

Conlusions

Patients with LMH may benefit from surgery, while monitored patients develop a progressive loss of visual acuity. Perihole peeling of epiretinal proliferation contributes to a better surgical outcome than conventional macular peeling, and reduces the risk of postoperative full-thickness macular hole development.

Financial Disclosure

None

Comments

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