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PARS PLANA VITRECTOMY FOR THE TREATMENT OF TRACTIONAL AND DEGENERATIVE LAMELLAR MACULAR HOLES: Functional and Anatomical Results

Figueroa, Marta S., MD, PhD*; Govetto, Andrea, MD†,‡; Steel, David H., MD§,¶; Sebag, J., MD**; Virgili, Gianni, MD††; Hubschman, Jean Pierre, MD

doi: 10.1097/IAE.0000000000002326
Original Study: PDF Only

Purpose: Functional and anatomical outcomes of vitrectomy with membrane peeling were compared in tractional lamellar macular holes (LMH)/macular pseudoholes (MPH) versus degenerative LMH.

Methods: This multicenter retrospective study enrolled patients with a minimum follow-up of 6 months. The association of spectral domain optical coherence tomography parameters with preoperative and postoperative best-corrected visual acuity was analyzed.

Results: Seventy-seven (74.8%) tractional LMH/MPH and 26 (25.2%) degenerative LMH were included. Preoperative best-corrected visual acuity was better in tractional LMH/MPH (0.39 ± 0.2 logarithm of the minimal angle of resolution, 20/50 Snellen equivalent) than degenerative LMH (0.56 ± 0.2 logarithm of the minimal angle of resolution, 20/66 Snellen equivalent; P < 0.001). Premacular membranes were found in all tractional LMH/MPH, whereas LMH-associated epiretinal proliferation (LHEP) was present in all degenerative LMH. Primary anatomical success was achieved in 97/103 eyes (94.2%), with foveal restoration occurring earlier in degenerative LMH (1.6 ± 2.3 vs. 3.3 ± 3.6 months; P = 0.025). Best-corrected visual acuity improved in both tractional LMH/MPH and degenerative LMH (P < 0.001 and P = 0.012, respectively) but was better in tractional LMH/MPH (P = 0.001).

Conclusion: The presence of premacular membranes and absence of LMH-associated epiretinal proliferation in all tractional LMH/MPH further distinguishes this from degenerative LMH. Best-corrected visual acuity improved in both subgroups but more so in tractional LMH/MPH. Complete anatomical restoration of foveal microanatomy was rare in degenerative LMH, reflecting significant morphological and pathophysiological differences between the two lesions.

Pars plana vitrectomy with membrane peeling in the treatment of tractional lamellar macular holes (LMH)/macular pseudoholes and degenerative LMH has greater functional improvement in the tractional LMH/macular pseudohole subgroup. Complete postoperative anatomical restoration occurred in the majority of tractional LMH/macular pseudohole lesions, but not in degenerative LMH.

*Retina Division, Department of Ophthalmology, Ramon y Cajal Hospital, University of Alcala de Henares, Madrid, Spain;

Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California;

Ophthalmology Department, Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy;

§Sunderland Eye Infirmary, Sunderland, United Kingdom;

Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom;

**VMR Institute for Vitreous Macula Retina, Huntington Beach, California; and

††Ophthalmology Department, Careggi Hospital, University of Florence, Italy.

Reprint requests: Andrea Govetto, MD, Department of Ophthalmology, Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Piazzale Principessa Clotilde, 3, 20121 Milan, Italy; e-mail: a.govetto@gmail.com

None of the authors has any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.