Abstract
Purpose :
Historically, lamellar macular holes (LMH) have been thought to remain stable over time. However, spectral domain OCT (SD-OCT) imaging has suggested that the natural history of LMHs can include progression, stability, and even regression. The purpose of this study was to determine the incidence of LMH progression and regression and to identify features that correlate with progression and regression.
Methods :
Retrospective cohort study of patients diagnosed with LMH over a 5-year period. Using a novel algorithm and MATLAB (MathWorks, Natick, MA), serial SD-OCT images were analyzed to determine the change in cross-sectional area of the LMH over time. Progression and regression were defined as ≥5% increase or decrease in area per year, respectively. The presence of epiretinal membrane (ERM), lamellar hole-associated epiretinal proliferation (LHEP), vitreomacular traction (VMT), and photoreceptor layer signal disruption were noted.
Results :
373 patients were diagnosed with LMH during the study period and 69 eyes of 69 patients were included in the analysis. The LMH progressed in 32 (46.4%) eyes, remained stable in 22 (31.9%) eyes, and regressed in 15 (21.7%) eyes. LHEP was seen in 17 (53.1%) eyes with LMH progression, 10 (45.5%) eyes with stability, and 1 (6.7%) eye with regression (Chi-Square 9.46, p = 0.009). ERM was found in 19 (59.4%) eyes with LMH progression, 17 (77.3%) eyes with stability, and 14 (93.3%) eyes with regression (Chi-Square 6.28, p = 0.043). Photoreceptor involvement was seen in 12 (37.5%) eyes with LMH progression, 5 (22.7%) eyes with stability, and 3 (20.0%) eyes with regression (Chi-Square 2.13, p = 0.344).
Conclusions :
Our study suggests that at least 50% of LMHs progress, while a smaller proportion regress. LHEP is associated with LMH progression, while ERM is associated with regression. We propose that LMH may represent a traumatic Muller gliopathy caused by vitreofoveal traction. Surgical implications of these findings include greater use of fovea-sparing ILM peeling and use of LHEP, when present, to reconstruct the fovea in eyes with full-thickness macular holes and surgical LMHs.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.