Purchase this article with an account.
A. J. Witkin, L. C. Castro, E. Reichel, A. H. Rogers, C. R. Baumal, J. S. Duker; Anatomic and Visual Outcomes of Vitrectomy for Lamellar Macular Holes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6052.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To assess anatomic and visual outcomes after pars plana vitrectomy for lamellar macular holes.
A retrospective case series of 18 eyes of 18 patients was performed. Charts of 746 patients who underwent vitrectomy surgery with membrane peel over a 6-year period were reviewed. A diagnosis of lamellar macular hole was made based on pre-operative OCT appearance. Lamellar holes were determined to be visually significant in 18 eyes of 18 patients, and these patients underwent 3-port pars plana vitrectomy with peeling of posterior hyaloid, epiretinal membrane, and/or internal limiting membrane, with or without air-fluid and air-gas exchange. Pre- and post-operative visual acuity, OCT appearance, and OCT foveal thickness was recorded.
Mean preoperative visual acuity was 20/159, and was 20/165 post-operatively. There was no statistically significant change in visual acuity after vitrectomy (p = 0.881). Mean preoperative foveal thickness was 372.61 µm and 246.77 µm post-operatively. This decrease in foveal thickness after vitrectomy was statistically significant (p = 0.001). Epiretinal membranes were peeled in 17/18 patients (94%), an adherent posterior hyaloid was peeled from the macula in 9/18 eyes (50%), and internal limiting membrane was peeled in 5/18 eyes (28%). Follow-up ranged from 1.5 to 76.4 months with a mean of 26.4 months. Two of 18 eyes (11%) developed full-thickness macular holes post-operatively; both of these eyes had foveoschisis visible on pre-operative OCT. Six of 18 eyes (33%) continued to have a lamellar macular defect on OCT post-operatively. One patient developed an inferior retinal detachment 1.5 months post-operatively. Eight of 18 eyes (44%) regained a relatively normal foveal contour after vitrectomy.
Despite post-operative anatomic improvement in many patients and an overall decrease in foveal thickness on OCT, there was no overall change in visual acuity after surgery. One third of the patients continued to have lamellar macular defects after surgery, and two eyes developed full-thickness macular holes, both of which had an appearance of foveoschisis pre-operatively. Overall, vitrectomy for lamellar holes is likely to improve macular anatomy, but visual improvement is less likely, suggesting a conservative approach when considering surgical repair of lamellar macular holes.
This PDF is available to Subscribers Only