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Shilla Lie, Christiane I. Falkner-Radler, Anelia Hochwarter, Eva Smretschnig, Susanne Binder; The Course of Lamellar Macular Holes assessed with Cirrus and Stratus OCT. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5214.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate vitreoretinal relationships and intraretinal changes in the course of lamellar macular holes (LMH).
Cirrus and Stratus OCT scans of 28 eyes were seen in regular intervals and reviewed in a mean follow-up of 13 months. The widest diameter and central retinal thickness (CRT) were determined and the LMHs examined for the presence of epiretinal membranes (ERM), posterior vitreous detachment (PVD), vitreopapillary adhesion (VPA), intraretinal cystoid spaces (ICS), break in the inner segment (IS)/ outer segment (OS) layer and in the external limiting membrane (ELM). Main outcome measures also included distance and near visual acuity (VA) and metamorphopsia via Amsler grid testing.
22 (79%) eyes had an ERM, 6 (21%) eyes had a PVD. 5 eyes with ERM underwent pars plana vitrectomy (PPV) for VA deterioration and metamorphopsia. The median LMH diameter increased (range 580 - 638 µm) in eyes under observation and decreased (range 682 - 237 µm) in surgical eyes, the median CRT decreased (range 296 - 284 µm) and increased (range 322 - 351 µm), respectively. The presence of VPA could only be investigated in 17 of 23 non-operated eyes. VPA was found in 10 (58,8 %) of 17 patients, 4 of these eyes increased in LMH diameter between 16 and 27 % (range 56 - 246 µm). ICS were found in 2 of 28 eyes, a break in the IS/OS layer and a break in the ELM in 4 and 2 eyes. The median distance VA of eyes under observation (range 42 - 45 EDTRS letters) and in surgical eyes (range 35 -30 EDTRS letters) was stable during follow-up. The median near VA of eyes under observation deteriorated 1 line logRad (0,3-0,2 logRad) and stayed stable in surgical eyes (0,4 logRad). 13 eyes under observation had metamorphopsia at baseline, 2 eyes deteriorated to positive grid testing.
The technical advantages of the Cirrus OCT were irrelevant for the diagnosis of the LMHs, but it was superior to the Stratus OCT in distincting IS/OS, ELM and ICS. An associated ERM was detected in 79 % of eyes. VPA was found in 10 patients. Eyes with VPA tended to a higher progression in LMH width. LMHs developed slowly with stable vision, but deteriorated slightly in reading vision. Future prospective investigations are required to study the role of VPA in the course of LMHs and to define guidelines for surgical intervention in patients with clinically relevant visual impairment.
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