Lamellar macular holes in the eyes with pathological myopia

Abstract

LMHs in highly myopic eyes are more prevalent in females, are frequently associated with ERM and LHEP, and show substantial stability of BCVA and the anatomic parameters evaluated with B-FAF and SD-OCT over years-long follow-up.

Lamellar Macular Hole: State of the Art

“…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]. …”

“…Figure 3a shows the comparison of BCVA between LMH associated with C ERM and LMH associated with A ERM ( p < 0.0001) [3, 4, 7-11, 22]. The difference in visual acuity may be explained by a greater involvement of outer intraretinal layers ( p = 0.0003) and of the ellipsoid zone and external limiting membrane (ELM), and by a lower residual foveal thickness in LMH associated with A ERM than in LMH associated with C ERM ( p = 0.00001) [3, 4, 8-10, 22] (Fig. 3b, c).…”

“…On the other hand, surgical peeling may cause iatrogenic damage to Müller cells [83] with consequent alteration of the retinal structure and possible evolution to FTMH. Peeling of an A ERM requires several and more aggressive surgical maneuvers than those required to peel a C ERM [3, 10, 11, 55, 63, 84, 85]. Furthermore, the composition of A ERMs is still unclear, leaving doubts about the real benefit from its complete removal.…”

“…These criteria clearly defined LMH, distinguishing it from other vitreoretinal disorders such as FTMH and macular pseudohole. However, the evolution of OCT and new studies highlighted the limitations of these criteria: LMH is not always characterized by an intact photoreceptor layer, and it is often associated with an epiretinal membrane (ERM) and intraretinal cysts (IRCs) [3-10]. Moreover, immunohistochemical and microscopic studies have shown differences in cell composition of ERMs, identifying two types of ERM.…”

Modern notions about the tactics of treatment of patients with non-full thickness macular holes: to observe or to operate?

“…Как правило, пациентам с высоким зрением чаще предлагают наблюдение с контролем ОКТ для динамической оценки морфологических показателей и зрительных функций [15][16][17][18][19][20][21][22][23][24][25].…”