Surgical outcomes of lamellar macular holes with and without lamellar hole‐associated epiretinal proliferation

Ko, Jeong-Sik; Kim, Gyu Ah; Lee, Sung Chul; Lee, Ji‐Hwan; Koh, Hyoung Jun; Kim, Sung Soo; Byeon, Suk Ho; Lee, Christopher S.

doi:10.1111/aos.13245

Cited by 59 publications

(71 citation statements)

References 24 publications

(97 reference statements)

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“…Macular hole (MH) surgery currently consists of pars plana vitrectomy (PPV), internal limiting membrane (ILM) peeling and gas tamponade (Kelly & Wendel 1991;Wendel et al 1993;Ko et al 2017;Hamoudi et al 2018). It has also been shown that MHs can be successfully treated with intravitreal ocriplasmin in cases of MHs associated with vitreomacular adhesion and vitreomacular traction (Jackson et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Best surgical technique and outcomes for large macular holes: retrospective multicentre study in Japan

Yamashita

Sakamoto

Terasaki

et al. 2018

Acta Ophthalmologica

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The purpose of this study was to compare the surgical outcomes of vitrectomy with conventional internal limiting membrane (C-ILM) peeling to that with the inverted ILM (I-ILM) flap technique for large macular holes (MHs). This was a retrospective chart review of consecutive cases with a large MH at nine hospitals in Japan. Among the 1342 eyes, 165 eyes of 165 cases met the inclusion criteria. The results for medium-large MHs with a diameter 400-550 μm were compared to that of eyes with an extra-large MH with a diameter >550 μm. In addition, the results of C-ILM peeling were compared to that of the I-ILM technique. In medium-large MHs, the closure rate was 95.2% (59/62) by C-ILM peeling and 100% (19/19) by the I-ILM technique. In extra-large MHs, the closure rate was 88.4% (38/43) by C-ILM peeling and 100% (41/41) by I-ILM. Although the difference between the two methods was not significant, the I-ILM technique was successful in 100% of the cases. Multiple logistic regression analysis showed the best-corrected visual acuity (BCVA) at 6 months was significantly associated with the preoperative BCVA, MH size, age and sex of the patient. Analyses of the eyes with extra-large MHs show that the surgical success is high, and the I-ILM technique is more effective for closure in eyes with extra-large MHs.

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Section: Introductionmentioning

confidence: 99%

Best surgical technique and outcomes for large macular holes: retrospective multicentre study in Japan

Yamashita

Sakamoto

Terasaki

et al. 2018

Acta Ophthalmologica

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“…In spite of these anatomical differences, most studies report no statistically significant results regarding LHEP-related LMH prognosis either with observation or after surgical management [4, 13, 14], with one paper reporting a worse visual outcome for patients with LMH and LHEP after surgery [10], and another citing an increase in LMH dimensions in correlation with the area of the LHEP [18]. …”

Section: Introductionmentioning

confidence: 99%

Epiretinal Proliferations Associated with Lamellar Macular Holes: Clinical and Surgical Implications

et al. 2018

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Objectives: To describe the prevalence of lamellar hole-associated epiretinal proliferation (LHEP) and to correlate this finding with lamellar macular hole (LMH) morphology and prognosis after a surgical or conservative approach. Methods: This is a retrospective multicenter case series comprising consecutive LMH patients followed for ≥6 months. Serial spectral-domain optical coherence tomographies were evaluated for the presence of epiretinal membrane (ERM) and LHEP, diameter of the LMH aperture, base, and floor thickness. Pars plana vitrectomy with ERM and internal limiting membrane peeling was performed in the surgical cases. Results: A total of 62 eyes from 57 consecutive patients were included. Mean follow-up time was 27.1 ± 19.8 months. LHEP was observed in 33 (53.2%) eyes. Patients with LMH and LHEP presented a larger external diameter (p = 0.001) and thinner floors (p = 0.018). Twenty-seven (81.8%) of the patients with LMH and LHEP presented a degenerative intraretinal cavitation, compared to 23.3% in the non-LHEP group (p = 0.001). No differences were observed in visual performance or closure rate between the 2 groups after surgery or in the subset of patients followed conservatively. Conclusions: LHEP was correlated with the anatomical conformation of the LMH, yielding thinner floors and larger external diameters. However, it did not correlate with the anatomical or functional results, both in the patients who underwent surgery and in those managed conservatively.

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“…6 These findings were supported by other investigations. 7 The baseline visual acuity, as well as improvement of visual acuity after surgery, has been reported as worse in LMH with LHEP, 8 although the results are controversial. 7 Govetto et al 9 suggested the possibility of three different mechanisms underlying the development of LMH, degenerative LMH, tractional LMH, and a combination of them.…”

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confidence: 99%

Evidence of Carotenoid in Surgically Removed Lamellar Hole-Associated Epiretinal Proliferation

Obana

Sasano

Okazaki

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To determine the constituents and origin of the yellow pigment in surgically removed lamellar hole-associated epiretinal proliferation (LHEP) in patients with lamellar macular hole (LMH).METHODS. This prospective case series comprised nine eyes with LMH in patients aged 41 to 83 years. The presence of LHEP was confirmed by preoperative optical coherence tomography; the distribution of macular pigment was observed by two-wavelength fundus autofluorescence technique before and after surgery. The subjects underwent a 25-gauge vitrectomy, and the surgically removed epiretinal membranous tissue was fixed with formalin. The specimens were examined using resonance Raman microscopy, and paraffin sections were stained with antiglial fibrillary acidic protein.RESULTS. Seven cases presented with LHEP, and the presence of yellow pigment was confirmed using an operating microscope. Carotenoid-specific Raman signals with three major Raman peaks could be identified in the specimens with LHEP. These specimens were positive for glial fibrillary acidic protein staining. Using the fundus autofluorescence technique, a central defect in the distribution of the macular pigment was noted in the exact area of the lamellar hole. This type of defect was no longer visible after surgical repair of the lamellar hole.CONCLUSIONS. The constituents of the yellow pigment in the removed LHEP were carotenoids that typically originate from the macular xanthophyll pigments at the fovea. Since LHEP is reported to be composed of Müller cells, we hypothesize that xanthophyll carotenoids at the fovea are contained in the Müller cells.

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Surgical outcomes of lamellar macular holes with and without lamellar hole‐associated epiretinal proliferation

Abstract: There was no visual benefit after surgery in LMH patients with LHEP. Different surgical indications for LMHs may be warranted based on the presence of LHEP-associated pathology.

Cited by 59 publications

References 24 publications

Best surgical technique and outcomes for large macular holes: retrospective multicentre study in Japan

Best surgical technique and outcomes for large macular holes: retrospective multicentre study in Japan

Epiretinal Proliferations Associated with Lamellar Macular Holes: Clinical and Surgical Implications

Evidence of Carotenoid in Surgically Removed Lamellar Hole-Associated Epiretinal Proliferation

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