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Cecile Truong, Royce Chen; A Case Series of Spontaneous Opening and Closing Macular Holes Associated with Lamellar Hole Epiretinal Proliferation. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5046.
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Lamellar hole epiretinal proliferation (LHEP) originates from vitreous material and occurs in 8% of patients with full-thickness macular holes (FTMH). Previously, several patients with LHEP were reported to have spontaneous opening and closing FTMH after cataract extraction or vitrectomy. Therefore, we hypothesize that the presence of LHEP is associated with idiopathic opening and closing of FTMH.
We retrospectively analyzed spectral domain optical coherence tomography (SD-OCT) scans of 73 consecutive patients diagnosed with macular holes, lamellar holes, and pseudoholes to find cases of spontaneous development and resolution of FTMH without surgical correction. We then analyzed those 8 patients for common factors, such as presence of traditional epiretinal membrane (ERM) and LHEP.
Out of 73 patients, 81 eyes were classified as having macular, lamellar, or pseudoholes. 8 of those 81 eyes (10%) had FTMH that spontaneously opened and closed. In those 8 eyes, 8 had LHEP (100%), 8 had traditional ERM (100%), 7 had complete PVD (87.5%), 5 had a history of cataract surgery (62.5%), 4 had glaucoma (50%), 4 had myopia (50%), 2 had uveitis (25%), and 2 had diabetes (25%). Four patients with spontaneously opening and closing FTMH (50%) eventually had vitrectomies, internal limiting membrane peels, and gas tamponades performed while the other 4 (50%) continued to be observed and maintained stable visual acuity. All 4 patients who underwent vitrectomy had successful closure with one operation and remained closed after the initial surgery.
Spontaneous opening and closing macular holes appear to be associated with the combination of both traditional ERM and LHEP. ERM exert tangential traction on the fovea, likely causing spontaneous macular holes in these eyes in the absence of vitreomacular traction. LHEP is predominantly composed of fibroblasts and hyalocytes, cells with less contractile properties than those found in standard ERM. LHEP may help to induce spontaneous closure of some macular holes. Depending on the severity and recurrence of ERM/LHEP-associated macular holes, some patients can continue to be observed while others require an operation.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
FTMH with ERM and LHEP (A) spontaneously closed several months after presentation (B) in Patient 1. The highly reflective vertical band in the foveola is suggestive of recent closure.
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