Pars Plana Vitrectomy With Gas Tamponade for Lamellar Macular Holes

Cystoid foveal oedema in symptomatic inner lamellar macular holes

“…These abnormalities may partially explain a reduced visual acuity and/or metamorphopsia. Haouchine et al 10 reported irregularities that were often present at the foveal base of the LMH, and Hirakawa et al 12 have suggested that such irregularities may be the reason for the relatively poor visual acuity. We assume that these irregularities could actually, in part, represent cystoid spaces and oedema at the fovea.…”

“…In comparison with another macular abnormality associated with ERM, that is, macular pseudoholes, one-third (9/27) of eyes showed an evolution into a full-thickness macular hole after 36 months of follow-up. 20 Although speculative, it is possible that the relative infrequent transition of an LMH to full-thickness hole, even under OCT evaluation, may [11][12][13] which is naturally broader in area than that of the original LMH opening, may allow release of the tangential tension with an improvement of visual acuity or metamorphopsia in most cases.…”

“…Several OCT studies on LMHs seem to suggest such dynamic properties: (a) two OCT studies report the transition of LMH to a full-thickness macular hole 9,13 and (b) improved visual acuity was achieved following PPV in most of the eyes in which ILM peeling was performed. [11][12][13] Garretson et al 11 reported the largest series of 27 patients with LMH, who underwent PPV and ILM peeling. Surgery was beneficial in 25 (93%) patients, with a mean gain of 43 Snellen lines of acuity.…”

“…[11][12][13] All of the above seem to give rise to a revised concern about LMHs in regards to their morphologic abnormalities, natural history, potential of worsening, and the possibility of beneficial surgery with reversibility of symptoms.…”

“…Recently, high-resolution imaging techniques, mainly OCT, were found useful in the visualization of retinal anatomy with near microscopic resolution, [4][5][6][7][8][9][10] and new data have been found regarding LMH: (a) best-corrected visual acuity (BCVA) as low as 20/200, 20/400 and counting fingers at 8 feet was reported in eyes with LMHs; [11][12][13] (b) several studies showed persistent vitreous adherence to the edge of the LMH, baring a potential for traction and LMH progression; [13][14][15] (c) two reports showed an LMH in each that underwent spontaneous transition to a full-thickness macular hole; 9,13 and (d) pars plana vitrectomy (PPV) and gas tamponade for symptomatic LMH improved visual acuity in most eyes, provided that it included peeling of the internal limiting membrane (ILM). [11][12][13] All of the above seem to give rise to a revised concern about LMHs in regards to their morphologic abnormalities, natural history, potential of worsening, and the possibility of beneficial surgery with reversibility of symptoms.…”