Visual outcomes and prognostic factors of vitrectomy for lamellar macular holes and epiretinal membrane foveoschisis

Fujishiro, Takashi; Asahina, Yuichi; Zhou, Han; Fujino, Ryosuke; Takao, Muneyuki; Obata, Ryo; Inoue, Tatsuya; Asaoka, Ryo; Maruyama-Inoue, Maiko; Yanagi, Yasuo; Kadonosono, Kazuaki

doi:10.1371/journal.pone.0247509

Cited by 14 publications

(12 citation statements)

References 18 publications

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“…In conjunction with a relative stabilized natural course, a surgical management is mainly indicated for those patients who experience progressive visual and/or anatomical deterioration. Several authors investigated beneficial effects of vitrectomy for conditions presenting with ERM and intraretinal schisis-like separation (defined as tractional LMH or MPH with stretched/cleavage edge) in terms of post-operative BCVA and OCT foveal structures [ 15 , 21 – 23 ]. Among those, Gaudric et al reported an overall visual improvement, assessed at 3 months or more post-operation, in both MPH with straight and cleavage foveal edge that had initial VA worse than 20/40 [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Visual acuity and anatomical changes following vitrectomy for epiretinal membrane foveoschisis: a case series

et al. 2021

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Purpose To evaluate the visual outcome and macular anatomic structures on spectral-domain optical coherence tomography (SD-OCT) of patients with epiretinal membrane (ERM) foveoschisis who underwent vitrectomy. Methods A retrospective cohort, interventional, case series. Participants Fourteen patients (14 eyes) with central vision loss from an ERM foveoschisis underwent vitrectomy at Chiang Mai University Hospital from 2017 to 2018 and had a follow-up period of 12 months. Interventions The 23G vitrectomy with ERM and internal limiting membrane (ILM) peeling was performed by a single surgeon. Main outcomes Best-corrected visual acuity (BCVA) and anatomic appearance on SD-OCT were assessed at the time of preoperative evaluations and post-operative follow-ups at 1, 3, 6, and 12 months. Results Fourteen patients with a mean (SD) age of 67.9 (7.9) years and a mean (SD) visual acuity (VA) of 0.6 (0.1) LogMAR units were included in this study. Significant VA improvements were observed at the 3-month (0.43 (0.14) LogMAR unit), 6-month (0.45 (0.16) LogMAR unit) and 12-month (0.37 (0.21) LogMAR unit) post-operative visits compared to baseline, all with P-values < 0.001. At month 12, there were vision improvements of ≥3 lines in 8 (57.2%) patients, vision improvements of 1 or 2 lines in 2 (14.3%) patients, vision remained at the same line of pre-operation in 3 (21.4%) patients, and vision decreased by 1 line in 1 (7.1%) patient. Regarding the anatomical outcomes, 13 (92.9%) patients achieved anatomical foveal restoration, while one had persistent intraretinal schisis at the 12-month follow-up. The median time to achieve a foveal restoration was 3 months. No significant visual impairments were observed post-operatively. Conclusion In patients with central vision loss from ERM foveoschisis, vitrectomy with ILM stripping tended to improve both visual and anatomical outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Recently, a study by Omoto et al, with an application of a consensus OCT definition, has demonstrated a significant visual gain at 3 months and at the final visit for ERM foveoschisis patients who underwent vitrectomy. For the LMH group, a significant visual improvement was observed only at the final visit [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Visual acuity and anatomical changes following vitrectomy for epiretinal membrane foveoschisis: a case series

et al. 2021

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“…They concluded that there was no surgical benefit for eyes with ERP [62]. In contrast, other investigators report that ERP did not affect surgical outcomes [27,49,53,55,131].…”

Section: Treatmentmentioning

confidence: 99%

“…Several pre-operative biomarkers, including pre-operative visual acuity, foveal thickness, ellipsoid zone integrity and the presence of ERP, have been explored as post-operative prognostic factors [ 62 , 130 , 131 ]. A poor pre-operative visual acuity (≤20/100), a thin fovea (≤100 µm), pre-operative ellipsoid zone disruption, absence of vitreopapillary adhesion or the presence of ERP were identified as poor prognostic signs for LMH undergoing surgical repair [ 62 , 130 , 132 ].…”

Section: Treatmentmentioning

confidence: 99%

Primary Lamellar Macular Holes: To Vit or Not to Vit

Bradshaw

2022

JCM

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There is a wide spectrum of macular conditions that are characterized by an irregular foveal contour caused by a break in the inner fovea. These include full-thickness macular hole (FTMH), foveal pseudocyst, lamellar macular hole (LMH) and macular pseudohole (MPH). Clinical examination of vitreomacular interface disorders is notoriously poor in differentiating these conditions. These conditions were initially described with slit-lamp biomicroscopy, and the main goal was to distinguish an FTMH from the others. The introduction of optical coherence tomography (OCT) has revolutionized our understanding of the foveal microstructural anatomy and has facilitated differentiating these conditions from an FTMH. However, the definitions of the other conditions, particularly LMH, has evolved over the past two decades. Initially the term LMH encompassed a wide spectrum of clinical conditions. As OCT became more widely used and observations became more refined, two different phenotypes of LMH became apparent, raising the question of different pathogenic mechanisms for each phenotype. Tractional and degenerative pathological mechanisms were proposed. Epiretinal membranes (ERMs) associated with each phenotype were identified. Typical ERMs were associated with a tractional mechanism, whereas an epiretinal proliferation was associated with a degenerative mechanism. Epiretinal proliferation represents Müller cell proliferation as a reactive process to retinal injury. These two types of ERM were differentiated by their characteristics on SD-OCT. The latest consensus definitions take into account this phenotypic differentiation and classifies these entities into LMH, MPH and ERM foveoschisis. The initial event in both ERM foveoschisis and LMH is a tractional event that disrupts the Müller cell cone in the foveola or the foveal walls. Depending on the extent of Müller cell disruption, either a LMH or an ERM foveoschisis may develop. Although surgical intervention for LMH remains controversial and no clear guidelines exist for pars plana vitrectomy (PPV), eyes with symptomatic, progressive ERM foveoschisis and LMH may benefit from surgical intervention.

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“…Recommendations for surgical intervention are rather reserved in literature. While studies suggest functional improvement in eyes with ERMF following surgery, most studies found no beneficial effect on VA in LMH (Androudi et al 2009;Casparis & Bovey 2011;Coassin et al 2018;Caretti et al 2020;Omoto et al 2021). Ko et al compared the surgical outcome of LMH with and without EP and found that eyes with EP preoperatively had a greater diameter, thinner fovea and a higher incidence of outer retinal disruption.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of neuroretinal integrity in optical coherence tomography‐graded eyes with partial‐thickness macular holes

Stino

Wassermann

Ristl

et al. 2022

Acta Ophthalmologica

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Purpose: To evaluate neuroretinal integrity in different subtypes of optical coherence tomography (OCT)-graded partial-thickness macular holes. Methods: Fovea-centred SD-OCT images (Cirrus, Carl Zeiss Meditec AG; Spectralis, Heidelberg Engineering GmbH) and visual acuity (VA) acquired at every visit were analysed by two retina specialists retrospectively in 71 eyes of 65 patients. Partial-thickness macular holes were classified as lamellar macular hole (LMH), epiretinal membrane foveoschisis (ERMF) or macular pseudohole (MPH). Results: Lamellar macular hole, ERMF and MPH were diagnosed in 33 (47%), 31 (43%) and 7 (10%) eyes with a VA of 0.18 AE 0.25, 0.15 AE 0.2, and 0.06 AE 0.08 (p = 0.323), respectively. Median follow-up time was 11 (interquartile range 4-32.5), 10 (interquartile range 5-18) and 19 (interquartile range 8-24) months in LMH, ERMF and MPH. In all subgroups, VA remained stable during the follow-up (p = 0.652, p = 0.915 and p = 1.000). Epiretinal proliferations (EP) were present in 12 LMH and 3 ERMF. At baseline, eyes with EP had significantly worse VA (p < 0.001), wider foveal cavities (p = 0.007) and thinner foveal floors (p < 0.001) compared with eyes without EP. Twelve out of 15 eyes with EP showed exudative cystoid spaces. Among all 71 eyes, 51 remained morphologically and functionally stable during follow-up. Conclusion: In our study cohort, EP are associated with worse VA and advanced neuroretinal tissue loss presenting with wider foveal cavities and thinner foveal floors. During the follow-up period, VA remained stable in all entities of partialthickness macular holes.

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Visual outcomes and prognostic factors of vitrectomy for lamellar macular holes and epiretinal membrane foveoschisis

Cited by 14 publications

References 18 publications

Visual acuity and anatomical changes following vitrectomy for epiretinal membrane foveoschisis: a case series

Visual acuity and anatomical changes following vitrectomy for epiretinal membrane foveoschisis: a case series

Primary Lamellar Macular Holes: To Vit or Not to Vit

Evaluation of neuroretinal integrity in optical coherence tomography‐graded eyes with partial‐thickness macular holes

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