Surgical therapy versus observation for lamellar macular hole: a retrospective comparison study

Abstract

BackgroundThe purpose of this study was to compare anatomic and visual changes in patients with lamellar macular hole undergoing pars plana vitrectomy with those in patients undergoing follow-up only.MethodsIn this retrospective consecutive case series study, we evaluated two groups of eyes, comprising 19 eyes from 19 patients with lamellar macular hole who underwent pars plana vitrectomy with internal limiting membrane peeling and 21 eyes from 21 patients with lamellar macular hole who had follow-up only. Corrected distance visual acuity (CDVA, in logMAR) and optical coherence tomography findings, including measurements of maximum diameter of lamellar defect and foveal thickness, and whether the inner segment/outer segment band was intact or not were documented at initial and follow-up examinations.ResultsAt initial examination, mean CDVA was 0.54 logMAR in the study group and 0.51 logMAR in the control group, and 0.33 logMAR and 0.55 logMAR, respectively, on final examination. In the study group, postoperative optical coherence tomography images were found to be normalized in ten patients (52.6%), improved in six (31.5%), unchanged in two (10.5%), and to have progressed to full-thickness macular hole in one (5.2%) in the intervention group, while all patients in the control group were found to have deteriorated within the follow-up period between March 2004 and June 2010.ConclusionIn patients with lamellar macular hole, combination treatment with pars plana vitrectomy and internal limiting membrane peeling appears to be effective, but further studies are required to establish new treatment modalities for patients who do not have a satisfactory outcome from treatment.

Lamellar macular defects: are degenerative lamellar macular holes truly degenerative?

“…Moreover, some authors have reported no visual improvement in LMH after surgery (8,14,15), which supports the degenerative hypothesis. However, there is increasing evidence that surgery may also be beneficial for patients with LMH (9)(10)(11)(12)(13)(14)(15)(16). This raises speculation regarding the true degenerative nature of LMH, since it remains to be understood whether a condition that can improve after surgery, and in most cases does not recur, can be defined as "degenerative.…”

“…Some previous studies have reported that LMH appears to be associated with worse outcomes after surgery (14,15), supporting the degenerative hypothesis, while others have found surgery to be beneficial for eyes showing disease progression (17,18). However, there are many discrepancies between these studies, preventing definitive conclusions.…”

“…However, studies with longer follow up periods have demonstrated the progression of these diseases, suggesting a slow, possibly degenerative evolution (13). Moreover, some authors have reported no visual improvement in LMH after surgery (8,14,15), which supports the degenerative hypothesis. However, there is increasing evidence that surgery may also be beneficial for patients with LMH (9)(10)(11)(12)(13)(14)(15)(16).…”

<p>Lamellar macular holes: monitoring and management strategies</p>

“…On the other hand, it could be conservatively concluded that a select group of patients with symptomatic LMHs and significant epiretinal traction may benefit from surgery. Nevertheless, it should be mentioned to the patient that up to 20% of patients undergoing vitrectomy for LMHs experience significant visual loss,28 and after surgery, the occurrence of a full-thickness macular lesion is not uncommon in these patients 27,28,35,36,39,40. LMHs are an extremely interesting condition where intraretinal and epiretinal forces play a unique role.…”

“…Mean BCVA improved from 0.54 to 0.33 logMAR in the operated group and decreased from 0.51 to 0.55 logMAR in the control group. Two eyes developed FTMHs after surgery 40. Parolini et al performed vitrectomy with ERM/ILM peeling in 19 eyes.…”