Macular structure on optical coherence tomography after lamellar macular hole surgery and its correlation with visual outcome

Abstract

Objective To report macular structure on optical coherence tomography (OCT) after lamellar macular hole surgery and its relationship with visual outcome. Design Retrospective interventional case series; private practice setting. Participants Twelve patients diagnosed with a lamellar hole who had undergone vitrectomy and who had OCT scanning before and after surgery and at least 6 months follow-up were included. Methods Surgery consisted of 25 g vitrectomy, peeling of epiretinal and internal limiting membrane, fluid/air/gas exchange, and 2 weeks of face-down positioning. Results OCT showed an epiretinal membrane in all cases. After a mean follow-up of 16.7 months, VA improved by ≥2 lines in nine patients and remained stable in three. There was a complete closure of the lamellar hole in ten patients; in four a retinal pseudocyst was found during the healing process, resolving spontaneously in two and persisting in the other two after 8 and 9 months, respectively. Two patients developed a full-thickness macular hole that closed successfully after surgical repair. All patients had a VA ≥ 20/32 at the end of follow-up. Conclusion Epiretinal membranes appear to have a role in the pathogenesis of lamellar macular holes. Vitrectomy is a useful technique to obtain closure of the lamellar hole and visual improvement. The presence of a retinal pseudocyst is a common feature during the healing process and is compatible with a favorable visual outcome. A full-thickness macular hole is a severe and not uncommon complication of this procedure.