Bilateral Lamellar Macular Hole Surgery in Retinitis Pigmentosa

Rush, Ryan B; Rush, Sloan W

doi:10.1097/icb.0000000000000166

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…Eyes with conditions complicated by chronic CME such as the Irvine-Gass syndrome [ 3 , 4 ], diabetic macular edema [ 78 ], ( Figure 4 ) retinal vein occlusions [ 78 , 79 , 80 , 81 , 82 ], retinochoroiditis [ 83 ], oculocutaneous albinism [ 84 ], age-related macular degeneration [ 85 , 86 ], ( Figure 5 ) retinitis pigmentosa [ 87 ], X-linked retinoschisis [ 88 ], myotonic dystrophy, Alport syndrome [ 89 ], Coats’ disease [ 90 ], high myopia [ 91 , 92 , 93 , 94 ], proliferative diabetic retinopathy [ 95 ], familial exudative vitreoretinopathy [ 96 ] and ocular trauma [ 97 , 98 ] may experience a spontaneous dehiscense of the roof of a cystoid space causing a LMH. This dehiscense may be triggered by vitreomacular traction by either an epiretinal membrane or the posterior hyaloid [ 78 , 99 , 100 ].…”

Section: Pathogenesismentioning

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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Section: Pathogenesismentioning

confidence: 99%

Primary Lamellar Macular Holes: To Vit or Not to Vit

Bradshaw

2022

JCM

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“…e presence of an operculum in front of the fovea would confirm this pathogenic theory [7]. ere are several papers describing the advent of LMHs in diseases associated with CME: post cataract surgery [1], diabetic macular edema [8], retinitis pigmentosa [9], and Coats' disease [10]. However, most cases of LMH are considered idiopathic [7] and it seems the pathogenesis of LMH cannot simply be attributed to abortive anteroposterior traction [11].…”

Section: Introductionmentioning

confidence: 99%

The Management of Lamellar Macular Holes: A Review

Danielescu

Stanca

Baltă

2020

Journal of Ophthalmology

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is literature review aims to provide the retina specialist with answers to patient's questions related to the management of lamellar macular holes (LMHs). Most LMHs are stable over time, but 13-21% present an anatomic decline after 18-24 months of follow-up. Nineteen point five percent of the eyes may experience a visual acuity (VA) loss of more than 5 letters after 3 years. Many surgeons choose to perform surgery when there is significant metamorphopsia or documented decline in VA over time. e typical surgery is phacovitrectomy with the epiretinal membrane and the internal limiting membrane peeling in previously phakic eyes (41.9 to 85.3% of the eyes). In the eyes that remained phakic, cataract surgery was often necessary within the first year of follow-up (19.2 to 40% of eyes). After surgery, a VA gain was recorded in 63-94% of eyes, but some eyes (between 0 and 20%) suffered some VA loss. Progression to full-thickness macular hole may occur after surgery, and thus a second surgical intervention may be needed.

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“…LMH is idiopathic in most cases, but it may be secondary to: cystoid macular edema due to metabolic or vascular retinal diseases [25-29], retinochoroiditis [30], age-related macular degeneration [31], retinitis pigmentosa [32], X-linked retinoschisis [33], myotonic dystrophy [34], Alport syndrome [35], Coats’ disease [36], high myopia [10, 37-40], ocular trauma [41, 42], or iatrogenic damage during intravitreal injection or surgery [43-48]. …”

Section: Pathogenesismentioning

confidence: 99%

Lamellar Macular Hole: State of the Art

Frisina

Pilotto

Midena³

2019

Ophthalmic Res

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Lamellar macular hole (LMH) is a vitreoretinal disorder characterized by an irregular foveal contour, a break in the inner fovea, dehiscence of the inner foveal retina from the outer retina, and the absence of a full-thickness foveal defect with intact foveal photoreceptors. The pathogenesis is only partially known. The advent of high-resolution optical coherence tomography has allowed distinguishing between two types of epiretinal membrane (ERM) associated with LMH: a conventional ERM (commonly found in macular pucker) and an atypical ERM (known by varied names: dense, epiretinal proliferation, or degenerative). These two types of ERM not only influence LMH morphology but also differ in cell and collagen composition. It remains unclear if these two types are indeed two distinct clinical entities or rather two stages of the same macular disorder. Studies of the natural evolution of LMH have not fully resolved this issue and also offered variable results. Surgical treatment leads to excellent anatomical and functional outcomes, but not without risks. This review provides a critical summary of the available data on LMH including some new insights.

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Bilateral Lamellar Macular Hole Surgery in Retinitis Pigmentosa

Abstract: Bilateral lamellar macular holes are rare occurrences in patients with retinitis pigmentosa; improved visual and anatomical outcomes can result after surgical intervention.

Cited by 4 publications

References 8 publications

Primary Lamellar Macular Holes: To Vit or Not to Vit

Primary Lamellar Macular Holes: To Vit or Not to Vit

The Management of Lamellar Macular Holes: A Review

Lamellar Macular Hole: State of the Art

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