Lamellar macular holes: tomographic features and surgical outcome

Abstract

Purpose: To categorize tomographically the distinct entity of lamellar macular holes (MH) and present the surgical outcomes in our patient cohort.

Design: Prospective observational and interventional study.

Methods: All cases were clinically diagnosed initially with slit-lamp biomicroscopy and confirmed with the use of optical coherence tomography (OCT)-3. Cases either were observed or underwent surgical intervention with a 25-gauge pars-plana vitrectomy (PPV) technique. Follow-up was at least 12 months for all cases and ranged from 12 to 46 months. Main outcome measures included closure of the lamellar MH following surgical intervention; best-corrected visual acuity (BCVA) preoperatively and postoperatively for the cases that underwent surgery.

Results: We identified 32 eyes of 30 patients with lamellar MH diagnosed by OCT-3. Lamellar MHs were classified into 3 different categories: 1) associated with macular epiretinal membrane (ERM) (20 eyes), 2) secondary to cystoid macular edema (8 eyes), and 3) attributable to partial-thickness macular avulsion after acute posterior vitreous detachment (PVD) (4 eyes). Visual acuity was less affected in cases with an associated ERM. Surgery included PPV and ERM removal (when present), followed by internal limiting membrane (ILM) removal and 16% C(3)F(8) injection. Postoperatively, BCVA improved in 17 out of the 20 cases (85%) operated from the first group of patients; 3 cases retained the same BCVA preoperatively and postoperatively. Mean BCVA improvement in the first group was 2.6 Snellen lines, which was statistically significant (P = .002, paired t test).

Conclusions: Surgical treatment of lamellar MH associated with an ERM may result in preservation or improvement of visual acuity, by relieving the tangential traction caused by the ERM.