Vitreo-papillary adhesion as a prognostic factor in pseudo- and lamellar macular holes

Abstract

Purpose To determine the incidence of vitreopapillary adhesion (VPA) and to investigate its value as a prognostic factor in the surgical outcome of pseudo-(PMH) and lamellar macular holes (LMH). Methods A total of 76 consecutive patients, diagnosed with PMH (41 eyes) or LMH (35 eyes) were included. Eyes with VPA were alternatively assigned to the surgical or control group. Surgery consisted of a 25G vitrectomy and internal limiting membrane peeling with blue dye staining. There were six visits: baseline, the day of surgery, and 1, 3, 6, and 9 post-operative months. Main outcome measures were the incidence of VPA and changes in the outer retinal layers and visual acuity. Results VPA was found in 27% (11/41) of patients with PMH and 37% (13/35) with LMH (P ¼ 0.03). In presence of VPA, the best-corrected visual acuity (BCVA) improved in the surgery group from 32±8 to 47±8 letters, whereas the control group went from 34 ± 7 to 31 ± 8 letters. The difference in letters between the surgery and control groups was statistically significant for both distance (P ¼ 0.032) and near (P ¼ 0.04) vision. Intra-retinal cysts were significantly correlated with a poor functional prognosis (P ¼ 0.01). We found the presence of focal damage to the outer retinal layers in LMH and PMH. Conclusion VPA is more frequent in the presence of LMH vs PMH. It significantly influences the tangential forces at the vitreoretinal interface, exacerbating anatomical changes, and worsening the functional prognosis. Functional difference between the surgical and control groups was statistically significant for distant and near vision in presence of VPA.

Functional and structural assessment of lamellar macular holes

“…It has been previously suggested that the presence of VPA may influence the tangential forces at the vitreoretinal interface, inducing anatomical changes up to the outer retinal layers 27. However our results showed a similar prevalence of outer retinal layer damage in LMH eyes with VPA or with complete PVD.…”

Retinal Changes Induced by Epiretinal Tangential Forces

“…In the absence of VPA, inward (centripetal) tangential traction likely throws the underlying retina into folds, resulting in MP. If the vitreous is still attached to the optic disc, the vectors of force could be changed, resulting in outward (centrifugal) tangential traction that induces central retinal dehiscence, MH [ 72 ], and/or ERM [ 73 ].…”

Prospective study of vitrectomy for epiretinal membranes in patients with good best-corrected visual acuity

“…The patient had no subjective perception that his BCVA had declined. It is sometimes difficult to improve BCVA in patients with pseudo-and lamellar macular holes with vitreous traction [29]. Therefore, caution is required when determining surgical indications in such 13 cases with good BCVA.…”