Natural History and Surgical Outcomes of Lamellar Macular Holes

Ismaël Chehaibou ,Christos Haritoglou ,J Sebag ,G Caputo ,Roberto Dell’omo ,Stanislao Rizzo ,Alain Gaudric ,Kazuaki Kadonosono ,Siegfried Priglinger ,Ricarda G Schumann ,Mathias Maier ,Marta S Figueroa ,Marc Veckeneer ,Ferdinando Bottoni ,Jean‐Pierre Hubschman ,Miroslav Stamenković ,Stanley Chang ,Christoph Leisser ,Ramin Tadayoni ,David Steel

doi:10.1016/j.oret.2023.09.016

Abstract

To assess the natural history and surgical outcomes of lamellar macular holes (LMH). Retrospective and consecutive case series. Patients with LMH from multiple tertiary care centers. Clinical charts and optical coherence tomography scans were reviewed. The visual acuity (VA) changes and the occurrence rate of full-thickness macular hole (FTMH) were studied in both groups. Within the operated group, factors associated with 6-month VA and development of (FTMH) were explored. 178 eyes were included, of which 89 were monitored and 89 underwent surgery. In the observation group, the mean VA decreased from 0.25 ± 0.18 to 0.28 ± 0.18 logMAR (p = 0.13), with 14 eyes (15.7%) that lost 0.2 logMAR VA or more, after 45.7 ± 33.3 months. Nine eyes (10.1%) spontaneously developed a FTMH. In the operated group, the mean VA increased from 0.47 ± 0.23 to 0.35 ± 0.25 logMAR at 6 months (p < 0.001) and 0.36 ± 0.28 logMAR (p = 0.001) after 24.1 ± 30.1 months. By multivariate analysis, better baseline VA (p < 0.001), the presence of an epiretinal membrane (p = 0.03), and the peeling of the ILM (p = 0.02), with a greater effect of ILM perihole sparing, were associated with a greater 6-month VA. Peri-hole ERP sparing was associated with a better postoperative VA by univariate analysis (p = 0.03), but this was not significant by multivariate analysis. Eight eyes (9.0%) developed a postoperative FTMH. Using cox proportional hazard ratio, pseudophakia at baseline (HR = 0.06 [0.00-0.75], p = 0.03) and peeling of the ILM (HR = 0.05 [0.01-0.39], p = 0.004) were protective factors, while ellipsoid zone disruption (HR = 10.5 [1.04-105], p = 0.05) was associated with an increased risk of FTMH. Observed eyes with LMH experience, on average, progressive VA loss. Patients with LMH and altered vision may benefit from surgery. Internal limiting membrane peeling, with perihole ILM sparing, represent a crucial step of the surgery associated with a greater VA and a lower risk of postoperative FTMH.

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