Clinical and OCT outcomes for full‐thickness and lamellar macular hole surgery

Abstract

AbstractPurpose Macular hole surgery has been long‐established practice in vitreoretinal surgery and yet there is still controversy over its management especially around the value of postoperative face‐down posturing on its outcome. Surgical indications for lamellar macular holes (LMH) are far more controversial. OCT has become the standard assessment tool for success evaluation and may even yield prognostic value.Methods Review of current published literature regarding posturing vs. non‐posturing for full‐thickness macular holes (FTMH), surgery vs. observation in lamellar macular holes (LMH).Results 21 studies investigating the effect of face‐down posturing on the outcome of macular hole surgery were identified. 11 studies included a comparison group and were deemed suitable for inclusion in the meta‐analysis. Of three RCTs, two suggested a benefit in larger holes but none demonstrated evidence of benefit in smaller holes. The lamellar macular hole group is much more heterogenous with some authors distinguishing between lamellar macular holes (LMH) and macular pseudoholes (MPH). Some morphological OCT changes, such as oedema, cystic spaces and lamellar holes were commonly seen in patients with epiretinal membrane (ERM). The presence or absence of an intact IS/OS layer may correlate with visual outcome.Conclusion The field surgery is constantly changing even for what is considered standard surgery in macular holes. The trend towards postoperative posturing seems to recur, especially for macular holes larger than 400μm. CONSORT‐adherent RCTs would be required to provide future guidance. Lamellar macular holes are still a poorly defined group with proponents and detractors in balance. The presence of concurrent ERM on OCT may tip the balance towards surgery.