Novel approaches to the assessment and treatment of lamellar macular hole

Abstract

To analyse morpho-functional foveal changes in eyes with lamellar macular hole (LMH) by an integrated assessment of short-wavelength fundus autofluorescence (SW-FAF) and microperimetry (SW-FAF/microperimetry integrated assessment) before and after treatment with a technique of double-inverted flaps of epiretinal proliferation (EP) and internal limiting membrane (ILM). Methods: Clinical and tomographic parameters were best-corrected visual acuity (BCVA), LMH size, central retinal thickness (CRT) and outer retinal layer integrity. SW-FAF/microperimetry integrated assessment allowed to analyse retinal sensitivity (RS) and FAF status of the fovea by an overlay of RS map on SW-FAF image. Follow-up was at baseline, 1, 3, 6 and 12 postoperative months. Results: Forty pseudophakic eyes. Hyper-FAF area was associated with larger LMH size (p = 0.0073) and inversely correlated with CRT (p = 0.021). Lower preoperative RS was observed in hyper-FAF than normo-FAF areas (p = 0.0117). External limiting membrane (ELM) defect was associated with worse BCVA (p = 0.0004). After surgery, BCVA improved (p = 0.001) and it was related to ELM recovery (p = 0.00483), hyper-FAF area decreased (p = 0.001), and RS increased (p = 0.440). Hyper-FAF points that normalized their FAF were associated with higher RS improvement compared to unchanged points. Conclusion: Short-wavelength fundus autofluorescence/microperimetry integrated assessment provides important information on the entity of damage of LMH and on postoperative recovery. Double-inverted EP and ILM flap technique is safe and effective for LMH treatment.

Case Report: Spontaneous Closure of Idiopathic Full-thickness Macular Hole and Early Development of Lamellar Hole

“…2E). The trend in retinal sensitivity changes confirms that inner retinal layers may contribute to visual performance with respect to the recognized role of photoreceptors in vitreoretinal surface disorders, as recent evidence suggested 9 …”

“…In this case report, the natural history of a spontaneous closure of an idiopathic full-thickness macular hole and its recurrence and reclosure detected by multimodal imaging will be discussed. The study evaluated the efficacy of a composite elaboration of short-wavelength fundus autofluorescence and microperimetry images to estimate the entity of damage seen by a topographical criterion (the superimposed method has been described in a previous published study) 9 . Moreover, the meaning of OCT and OCT-angiography changes over time, and both were studied by a quantitative and accurate method to test the retinal sensitivity and the macular function.…”

Macular Holes: Main Clinical Presentations, Diagnosis, and Therapies

“…As presented before, OCT plays an important role in the evaluation of LMH structure and morphology. Recent studies have shown interesting results using short-wavelength fundus autofluorescence (SW-FAF) [ 70 ] and microperimetry to assess retinal sensitivity (RS) [ 68 , 70 ]. Larger LMHs show hyper-FAF area combined to lower preoperative RS.…”

“…After surgery, the hyper-FAF area decreased, and RS increased. The reduction of FAF to physiological features is associated with higher RS and a whole functional improvement [ 70 ]. These further evaluations will help to better evaluate surgical indications for LMH.…”

“…This surgical technique is based on the construction of a double inverted ERM and ILM flap around the edges of the LMH, following the concept of the inverted flap technique proposed by Michalewska et al for the treatment of large FTMHs. The surgical rationale is to release the tangential traction on the LMH without complete removal of ERM and ILM from the edges of LMH, and the creation of 3 or 4 flaps to take the advantages of the properties of ERM and ILM flaps to induce cell reproliferation and restoration of the foveal architecture [ 70 ].…”