Outcomes from the Retrospective Multicenter Cross-Sectional Study on Lamellar Macular Hole Surgery

Abstract

Purpose To analyze the functional and anatomical parameters of lamellar macular hole (LMH) surgery with internal limiting membrane peeling and determine which surgical technique provides the best visual outcome. Methods This is a retrospective multicenter cross-sectional study on patients who underwent pars plana vitrectomy (PPV) for LMH with or without combined phaco-vitrectomy, as well as gas-, air- or BSS-tamponade. Pre- and postoperative examination included best corrected visual acuity (BCVA) measurements for functional comparison and optical coherence tomography (OCT) scans to determine the contributing anatomical parameters. Results A total of 66 consecutive patients were included (age: 71.79 ± 8.52 years), of which 47 (71.2%) were diagnosed as tractional type LMH, and 19 patients (28.8%) as degenerative type. An epiretinal membrane (ERM) was present in 63 of the patients (95.5%), LMH-associated epiretinal proliferation (LHEP) was present in 19 patients (28.8%), and 16 patients (24.2%) had concomitant ERM and LHEP. In the group of tractional LMH, the mean central foveal thickness (CFT) was 81.1% thicker (P < 0.05) than in the degenerative group. Thirty-one patients (47.0%) underwent a combined phaco-vitrectomy procedure, while the rest underwent 23G, 25G or 27G PPV. Seventeen of the 66 patients received gas-tamponade (25.7%)-either SF 6 or C 3 F 8 , 26 received air-tamponade (39.4%), while the remaining 23 patients received balanced salt solution (BSS)-tamponade (34.9%) during vitrectomy. The total BCVA showed significant improvement postoperatively (p < 0.001) and accordingly in the following groups: tractional LMH type (p < 0.001), degenerative type (p < 0.001), simple PPV (p < 0.001), phaco-vitrectomy (p < 0.001), BSS injection (p < 0.01), gas-tamponade (p < 0.05). None of the patients included in the study developed a full thickness macular hole postoperatively. Conclusion PPV provided a high success rate and functional improvement for treating LMH for both tractional and degenerative types, as well as combined phaco-vitrectomy treatment when cataract was present.

Primary Lamellar Macular Holes: To Vit or Not to Vit

“…Invariably many of the early series included both ERM foveoschisis and LMH eyes without differentiating between these two different conditions. Some authors suggest that there is no evidence that justifies PPV [ 8 , 10 , 11 ], while others feel that vitrectomy should be reserved for cases where the visual acuity continues to decrease or when the macula experiences progressive macular thinning [ 27 , 112 ]. Others have shown that PPV with ERM and ILM removal improves the visual and anatomic outcomes [ 10 , 12 , 13 , 113 , 114 , 115 , 116 , 117 ].…”

Macular hole Delphi consensus statement (MHOST)

“…A moderate consensus was reached in the remaining items. Among them, it emerged that surgeons still feel safer tamponading LMH with SF 6 instead of BSS (Haave et al, 2022). Noteworthy, all the items pertaining the approach of refractory or recurrent FTMH showed only a moderate consensus among all the participants.…”

Vitreous Substitutes from Bench to the Operating Room in a Translational Approach: Review and Future Endeavors in Vitreoretinal Surgery

“…A plethora of retinal conditions exist that require pars plana vitrectomy (PPV) and subsequent injection of a vitreous substitute into the vitreous chamber such as retinal detachment (RD), proliferative diabetic retinopathy, macular holes and ocular trauma [ 1 , 2 , 3 , 4 , 5 ]. Among these, RDs treated with PPV are the cornerstone condition in which all the properties of an artificial, temporary vitreous substitute come into play for a successful clinical and anatomical result [ 6 , 7 ].…”