Spontaneous Conversion of Lamellar Macular Holes to Full-Thickness Macular Holes: Clinical Features and Surgical Outcomes

Chehaibou, Ismaël; Hubschman, Jean‐Pierre; Kasi, Sundeep; Joseph, Anthony; Prasad, Pradeep; Abbey, Ashkan M.; Gaudric, Alain; Tadayoni, Ramin; Rahimy, Ehsan

doi:10.1016/j.oret.2020.12.023

Cited by 16 publications

(19 citation statements)

References 27 publications

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“…Based on these findings, it is possible that, in some patients in the study group, the evolution of an LMH to an FTMH occurs even when persistent broad VMA remains. Previous studies have reported a few cases of LMH progressing to FTMH, 12,24,25 and the mechanism for this progression could include tangential traction from ERM or a progressive alteration of the foveal architecture due to disruption of the outer retinal layers in the LMH. However, postoperative visual acuity is known to be poor in most patients with FTMH derived from LMH, which differs from our results wherein good visual outcomes were achieved.…”

Section: Discussionmentioning

confidence: 99%

Full-Thickness Macular Hole With Persistent Broad Vitreomacular Attachment

Uemura

Yamakiri

Santo

et al. 2023

Retina

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Section: Discussionmentioning

confidence: 99%

Full-Thickness Macular Hole With Persistent Broad Vitreomacular Attachment

Uemura

Yamakiri

Santo

et al. 2023

Retina

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“…Up to 25% of eyes with a FTMH demonstrate the presence of LHEP [ 46 , 51 ]. Since conditions other than LMH have been associated with LHEP, we and others favor the use of the term of epiretinal proliferation (ERP) rather than LHEP [ 17 , 52 ].…”

Section: Epiretinal Proliferation (Erp)mentioning

confidence: 99%

“…In these cases, the macular hole diameter was typically small, the edges were flat and there was limited retinal hydration. Although most FTMH closed following surgical repair, the resulting visual acuities were relatively poor [ 52 ].…”

Section: Natural Historymentioning

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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“…The presence of EP was identified in 38 (13.5%) of 282 eyes, consistent with the prevalence reported in previous studies for IMHs. 4,7 FTMHs with EP, including IMHs, have been speculated to originate from LMHs, 4,[6][7][8]16,26,27 with evidence showing that some LMHs with EP progress to FTMHs on OCT images. 4,6,8,16,26,27 However, because sequential OCT images are difficult to collect in all FTMHs with EP, its pathogenesis remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Surgical Prognosis of Idiopathic Macular Holes With Epiretinal Proliferation

Yang

et al. 2023

Retina

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Purpose: To investigate the clinical features and surgical outcomes of idiopathic macular holes with epiretinal proliferation (EP).Methods: This retrospective study included 282 eyes of 269 consecutive patients who underwent vitrectomy for idiopathic macular holes. Clinical demographic data, baseline and postoperative retinal microstructure features on optical coherence tomography images, best-corrected visual acuity, and postoperative closure rate were compared between eyes with and without EP.Results: EP was identified in 38 of 282 eyes (13.5%). Eyes with EP had a significantly longer symptom duration (P = 0.019), higher frequency of pseudophakic conditions (P = 0.034), presence of epiretinal membrane (P , 0.001), and a larger base diameter (P = 0.014) than those without EP. In addition, compared with eyes without EP, those with EP had a higher percentage of U-type closure (P = 0.047) and a thicker central fovea (P = 0.012) at 1 month postoperatively and a significantly lower frequency of ellipsoid zone disruption (P = 0.033) and outer foveolar lucency (P = 0.021) and a thicker central fovea (P = 0.004) at 10 months postoperatively. Conclusion:The presence of EP represents a more chronic pathogenic process but has no negative effect on postoperative outcomes and can even facilitate anatomical recovery after surgery.

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Spontaneous Conversion of Lamellar Macular Holes to Full-Thickness Macular Holes: Clinical Features and Surgical Outcomes

Cited by 16 publications

References 27 publications

Full-Thickness Macular Hole With Persistent Broad Vitreomacular Attachment

Full-Thickness Macular Hole With Persistent Broad Vitreomacular Attachment

Primary Lamellar Macular Holes: To Vit or Not to Vit

Clinical Characteristics and Surgical Prognosis of Idiopathic Macular Holes With Epiretinal Proliferation

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