Abstract
PurposeTo assess the efficacy of vitrectomy in degenerative and tractional lamellar macular holes (LMHs) by meta-analysis of published studies.MethodsPubMed, Medline and Embase databases were searched up to May 2020. Included cohorts were divided into three groups: degenerative LMH group, lamellar hole associated epiretinal proliferation (LHEP) group and tractional LMH group. LHEP is likely to be associated with degenerative LMHs, but less commonly could be associated with mixed LMHs. To reduce risk of possible misclassification bias, eyes with LHEP which could not have been precisely classified by the authors, were included into the LHEP group. The primary outcome was to investigate the visual change following primary vitrectomy in the degenerative LMH and LHEP group versus the tractional LMH group. A sensitivity analysis excluding the LHEP group was also performed on the primary outcome. Mean difference (MD) in best corrected visual acuity between baseline and post-treatment was calculated, along with 95% confidence interval (CI). Rate of incidence of post-operative full-thickness macular hole (FTMH) was assessed as secondary outcome.ResultsThirteen studies were included. Pooled analyses including all groups showed a significant visual improvement following vitrectomy (pre-post MD = -0.17;95%CI = -0.22,-0.12;p<0.001), with no difference in visual improvement between the degenerative LMH and LHEP group and the tractional LMH group. The sensitivity analysis excluding LHEP group confirmed no difference in visual change between the degenerative LMH group (pre-post MD = -0.18;95%CI = -0.24,-0.12;p<0.001) and the tractional LMH group (MD = -0.16;95%CI = -0.26,-0.07;p<0.001). The incidence rate of post-operative FTMH was higher in the degenerative LMH and LHEP group than in the tractional LMH group (p = 0.002).ConclusionPrimary vitrectomy for LMH ensured a favorable visual outcome, with no difference in visual gain between degenerative and tractional LMHs. However, a higher incidence of post-operative FTMHs was found in eyes with the degenerative LMH subtype.
Highlights
Since the first optical coherence tomography (OCT)-based description was published in 1998, the definition of lamellar macular hole (LMH) has continued to be refined [1]
The sensitivity analysis excluding lamellar hole-associated epiretinal proliferation (LHEP) group confirmed no difference in visual change between the degenerative LMH group and the tractional LMH group (MD = -0.16;95%confidence interval (CI) = -0.26,0.07;p
The incidence rate of post-operative full-thickness macular hole (FTMH) was higher in the degenerative LMH and LHEP group than in the tractional LMH group (p = 0.002)
Summary
Since the first optical coherence tomography (OCT)-based description was published in 1998, the definition of lamellar macular hole (LMH) has continued to be refined [1]. This is because major advances in OCT technology have significantly improved the ability to study the foveal contour, the integrity of the outer retinal layers and the epiretinal materials associated with LMH. In 2016, Govetto and coworkers proposed classifying LMHs into two subtypes, which are characterized by different pathogenetic and clinical features: degenerative LMH and tractional LMH [3] Distinctive features of the former one are the presence of lamellar hole-associated epiretinal proliferation (LHEP), foveal bump and, in most cases, an ellipsoid disruption. This classification has become a landmark in this field, gaining significant clinical relevance when it comes to the management of the two LMH subtypes
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