Abstract
PurposeTo evaluate the clinical characteristics and evolution of lamellar macular hole (LMH) in high myopia and the parameters associated with structural worsening, defined as the development of foveal detachment or full-thickness macular hole.MethodsPatients with high myopia and LMH were retrospectively recruited. The clinical characteristics and various parameters of optical coherence tomography were identified at baseline and during follow-up visits. Cox regression analysis was used to evaluate the hazard ratios for foveal detachment and full-thickness macular hole.ResultsAmong 112 eyes (98 patients), 64.3% were female; the mean axial length of all eyes was 29.6 ± 1.9 mm. The ‘LMH without retinoschisis’ group accounted for 39.3% of the eyes. Forty-two percent developed structural worsening within a median follow-up of 67 months. Multivariable regression on all cases showed elevated tissue inside the LMH (P = 0.003) protected against structural worsening while V-shaped LMH (P = 0.006) predicted it. In the “LMH with retinoschisis group”, ellipsoid zone disruption (P = 0.035), and V-shaped LMH (P = 0.014) predicted structural worsening, while elevated tissue inside the LMH (P = 0.028) protected against it. In the “LMH without retinoschisis group”, no associated factor was identified.ConclusionsLMHs in high myopia are unstable, especially those with V-shaped LMH. Elevated tissue inside LMHs have a protective effect against further structural worsening.
Highlights
Lamellar macular hole (LMH) is a common macular structural abnormality in patients with high myopia (4.8%–20.7%) [1, 2]
Elevated tissue inside LMHs have a protective effect against further structural worsening
Studies on myopic traction maculopathy (MTM) in general have shown that, when foveal retinoschisis advances to retinoschisis with foveal detachment (FD), the probability of full-thickness macular hole (FTMH) formation is very high [2]
Summary
Lamellar macular hole (LMH) is a common macular structural abnormality in patients with high myopia (4.8%–20.7%) [1, 2]. The clinical course of LMH may be more complicated than that in idiopathic LMH because the adherent vitreous cortex and epiretinal membrane exert a complex anteroposterior and tangential traction, and because the internal limiting membrane (ILM) is rigid and posterior staphyloma is often present [3,4,5]. Some LMHs may stay unchanged or show minimal progression for many years, while others may progress to full-thickness macular hole (FTMH) or macular hole with retinal detachment (MHRD), causing severe vision loss [6,7,8]. In highly myopic eyes, LMH may exist alone or in association with retinoschisis [3, 5, 9], and it is unclear whether these two different types of LMH exhibit different clinical characteristics and outcomes
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