Visual outcomes and prognostic factors of vitrectomy for lamellar macular holes and epiretinal membrane foveoschisis.

Takashi Omoto,Han Peng Zhou,Ryo Asaoka,Ryosuke Fujino,Maiko Maruyama-Inoue,Kazuaki Kadonosono,Yuichi Asahina,Yasuo Yanagi,Ryo Obata,Tatsuya Inoue,Muneyuki Takao,Demetrios G Vavvas

doi:10.1371/journal.pone.0247509

Takashi Omoto, Han Peng Zhou + Show 10 more

Open Access

https://doi.org/10.1371/journal.pone.0247509

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Journal: PloS one	Publication Date: Feb 22, 2021
Citations: 8	License type: CC BY 4.0

Affiliation: The University of Tokyo, Yokohama City University

Abstract

PurposeTo evaluate the visual outcomes of vitrectomy for lamellar macular hole (LMH) and epiretinal membrane (ERM) foveoschisis and to investigate the prognostic factor for postoperative visual acuity.MethodsWe retrospectively reviewed 15 LMH and 17 ERM foveoschisis eyes that had undergone a standard three-port pars plana vitrectomy with (12 eyes) or without (20 eyes) cataract surgery. Best-corrected visual acuity (BCVA) at postoperative three months and the final visit were compared to the preoperative measurements. We investigated the relationship between BCVA at the final visit and baseline parameters (age, preoperative BCVA, the presence of epiretinal proliferation [EP] and ellipsoid zone [EZ] disruption). The best explanatory variables for the final BCVA were investigated using the corrected Akaike information criterion (AICc) model selection.ResultsThe mean age was 67.2 years. The mean follow-up duration was 30.7 months. Fifteen of 32 examined eyes were diagnosed as LMH and 17 eyes as ERM foveoschisis. Twelve eyes in LMH had EP and 13 eyes showed the disruption of EZ integrity. In total, BCVA significantly improved at 3 months postoperatively (p = 0.0013). A significant improvement was observed in ERM foveoschisis (p = 0.0085) but not in LMH group (p = 0.071). Comparing the BCVA between the baseline and the final visit, significant improvements were observed in total, ERM foveoschisis and LMH group (p<0.001, p<0.001 and p = 0.026, respectively). The optimal model for BCVA at the final visit included preoperative BCVA and the presence of EZ disruption (p<0.001 and p<0.001, respectively).ConclusionOur results suggested that the final BCVA was dependent on preoperative BCVA and the presence of EZ disruption. Surgical indications might be warranted for LMHs with EZ disruption.

Highlights

Recent advances in optical coherence tomography (OCT) in decades has provided us precise information of retinal imaging
Fifteen of 32 examined eyes were diagnosed as lamellar macular hole (LMH) and 17 eyes as epiretinal membrane (ERM) foveoschisis
Twelve eyes in LMH had epiretinal proliferation (EP) and 13 eyes showed the disruption of ellipsoid zone (EZ) integrity

Summary

Introduction

Recent advances in optical coherence tomography (OCT) in decades has provided us precise information of retinal imaging These improvements have facilitated more detailed analyses, which have resulted in more accurate diagnoses of various vitreo-interface-associated disorders, including lamellar macular hole (LMH) [1]. Govetto et al [4] suggested that the presence or absence of this peculiar EP alone was not sufficient to subclassify LMHs because EP is not specific to LMHs: eyes with ERMs and non-lamellar macular holes may have this entity. Instead, they proposed that LMHs be divided into degenerative and tractional types according to morphological and functional characteristics. Recent studies reported poor surgical outcomes of LMHs with EP [5, 6] and other researches proposed the association between EZ disruption and poor visual outcomes [7, 8]

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