Natural course and efficacy of treatment of lamellar macular holes
DOI:
https://doi.org/10.31288/Ukr.j.ophthalmol.202636167Keywords:
lamellar macular hole, retina, vitrectomy, optical coherence tomography, epiretinal membraneAbstract
Purpose: To investigate the natural course of lamellar macular holes (LMH), identify possible pathways for their formation, and assess the efficacy of surgical treatment for them.
Methods: LMH were generally classified into tractional and degenerative based on optical coherence tomography (OCT) findings. Of the 60 patients included in the study, 41 were managed conservatively (group 1), and 19, surgically (group 2). All 19 patients in group 2 had tractional LMH. Patients from the conservative treatment group were subdivided into two subgroups, subgroup 1a of 18 patients (18 eyes) with tractional LMH, and subgroup 1b of 23 patients (23 eyes) with degenerative LMH. The minimum retinal thickness (MRT) and inner and outer diameters and depth of LMH were measured. Surgically managed patients underwent a 25G three-port pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling.
Results: In subgroup 1a, best-corrected visual acuity (BCVA) at baseline, 6 months and 12 months was 0.18 ± 0.16 logMAR (18 eyes), 0.19 ± 0.16 logMAR (18 eyes) (p = 0.5), and 0.22 ± 0.15 logMAR (16 eyes) (p = 0.07). Additionally, the outer and inner diameters of LMH increased significantly (p = 0.042 and p = 0.037, respectively), while MRT decreased significantly, from baseline to 12 months. In subgroup 1b, BCVA at baseline, 6 months and 12 months was 0.2 ± 0.18, 0.22 ± 0.18 logMAR (p = 0.08), and 0.28 ± 0.19 logMAR (p = 0.006), respectively. Additionally, the outer diameter of LMH increased from 769.53 ± 254.01 µm to 821.73 ± 253.78 µm (p=0.04) from baseline to 12 months. In group 2, BCVA at baseline, 1 month and 6 months was 0.34 ± 0.27, 0.36 ± 0.32 logMAR (p = 0.67), and 0.28 ± 0.24 logMAR (p = 0.75), respectively. Moreover, at 1 month, LMH closure was seen in 18 of the 19 eyes (94.7%). We established three mechanisms of tractional LMH formation, with these mechanisms being associated with intraretinal cystic cavities.
Conclusion: The natural course of degenerative LMH was generally stable, whereas tractional LMH apparently tended to worsen anatomical OCT parameters. We found three developmental pathways for the formation of tractional LMH. Tractional LMH surgery with PPV and ERM and ILM peeling resulted in hole closure in 94.7% of the eyes.
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