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J. C. Chen, L. R. Lee; Anatomical and Functional Outcomes of Lamellar Macular Hole Surgery. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4691.
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To investigate the anatomical and functional outcomes of surgical management of lamellar macular holes.
Ninety-five eyes of 84 consecutive patients between 2004 and 2007 with a clinical diagnosis of lamellar macular hole who underwent pars plana vitrectomy at a single ophthalmology centre were retrospectively reviewed. Twenty-six of the 95 eyes (27.4%) underwent standard three-port pars plana vitrectomy with indocyanine green dye assisted internal limiting membrane peeling and perfluoro-propane gas tamponade, followed by face-down posturing for two weeks. Pre- and post-operative visual acuity (VA) were compared and the anatomical outcome of vitrectomy was examined by studying the restoration of the foveal contour on Optical Coherence Tomography (OCT) scans.
Eyes which underwent vitrectomy had poorer VA and deeper lamellar defects at initial presentation compared to non-vitrectomized eyes (t 93 = 5.404, p < 0.0001; t 93 = 2.219, p = 0.029). The presence of associated epiretinal membrane was also greater in eyes which underwent vitrectomy (77% vs 42%). Anatomical closure of lamellar macular holes was achieved with a single surgical procedure in all vitrectomized eyes as confirmed biomicroscopically and/or by OCT. VA improved in 23 eyes (88.5%), from 0.44±0.28 logMAR pre-operatively to 0.26±0.20 logMAR post-operatively (t25 = 3.725, p = 0.001). The median post-operative follow-up period was 13 months (range 3-33 months). No post-operative epiretinal formation or re-opening of any lamellar macular hole was observed during the follow-up period.
Pars plana vitrectomy provided a high success rate of anatomical and functional improvement for lamellar macular holes. The study found that surgical intervention is recommended for eyes with deep lamellar macular defects, poor VA, and the presence of associated epiretinal membrane.
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