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Won Seok Choi, Stanley Chang; Surgical outcomes of vitrectomy for lamellar macular hole.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1074.
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© 2017 Association for Research in Vision and Ophthalmology.
Lamellar macular hole (LMH) is a partial-thickness foveal defect that generally has preserved visual acuity. Some LMH cases show progression and gradual vision loss, sometimes to full-thickness macular hole (FTMH). The surgical outcomes have been controversial. Recently it was postulated eyes with a hypodense perifoveal material (HPM) around the fovea has worse surgical outcomes. In this study, we compared the vitrectomy outcomes of different stages of LMH and FTMH in eyes with hypodense to highly reflective membranes.
All clinical records of patients who had vitrectomy due to FTMH or LH between March 2009 and April 2015 were reviewed. Thirty-three patients were enrolled for this study. The patients were divided into three groups depending on the type of macular hole and presence of HPM on the retinal surface. Group 1 consists of the patients having epiretinal membrane and LMH without HPM, group 2 (Figure 1) consists of the patients having LMH with predominantly HPM and group 3 (Figure 2) patients having FTMH with HPM. Before and after surgery, OCT scans were obtained and the best corrected visual acuity (BCVA) was recorded. Postoperative anatomical recovery and the presence of ellipsoid zone disruption were evaluated by OCT. The duration of LMH, development of ellipsoid layer changes were documented to evaluate the correlation with final visual outcome.
Preoperative BCVA showed no statistically significant difference between groups; group 1 showed 0.32 ± 0.11, group 2 showed 0.38 ± 0.18 and group 3 showed 0.38 ± 0.17. After surgery, BCVA of group 2 on final follow-up visit was lower than other 2 groups; 0.68 ± 0.22 in group 1, 0.42 ± 0.23 in group 2 and 0.68 ± 0.26 in group 3. Group 1 showed lower rate of ellipsoid zone disruption in postoperative OCT (2/11) compared to group 2 (6/11). And the duration of HPM to surgery had no significant correlation with postoperative visual acuity (r=0.629, p = 0.175).
LMH patients with hypodense epiretinal tissue had poorer visual outcomes compared with those with highly reflective ERMs. LMH patients with hypodense membranes had a greater chance of ellipsoid zone disruption. These findings may explain the wide variability of visual outcomes previously reported after vitrectomy for LMH.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
OCT image shows LMH with HPM (yellow arrows and areas surrounded by yellow dotted lines)
OCT image shows FTMH with HPM (yellow arrows and areas surrounded by yellow dotted lines)
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