Novel approaches to the assessment and treatment of lamellar macular hole

Herein, we report the longitudinal observation of a case with reopening of the macular hole associated with a lamellar macular hole-associated epiretinal proliferation (LHEP) followed by spontaneous closure in patients with stage 2 idiopathic macular hole. A 64-year-old woman was referred for the decreased visual acuity (VA) and acute anorthopia in the right eye. Funduscopy and optical coherence tomography (OCT) showed stage 2 full-thickness macular hole without posterior vitreous detachment (PVD) and operculum formation. Her best-corrected visual acuity (BCVA) was 20/32. One month later, the diameter of the macular hole was getting small and VA improved. Six months later, the macular hole was treated spontaneously with the attached hyaloid membrane to the macula by OCT and the BCVA improved to 20/20. Fourteen months after the first visit, the BCVA decreased to 20/50 and the patient was diagnosed with stage 4 macular hole with complete PVD. OCT showed full-thickness macular hole with a LHEP in the right eye. After 25G-gauge vitrectomy with the peeling of internal limiting membrane (ILM) and LHEP, the macular hole was closed and BCVA finally improved to 20/25. Spontaneous macular hole closure without PVD may rarely occur in patients with LHEP. The surgical removal of ILM and LHEP may contribute to the successful macular hole closure after vitrectomy.

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A case of unilateral retinitis pigmentosa with lamellar macular hole

Journal of Retina-Vitreous ◽

10.37845/ret.vit.2020.29.28 ◽

2020 ◽

Vol 29 (2) ◽

pp. 157

Author(s):

Hasan KIZILTOPRAK ◽

Kemal TEKIN ◽

Mehmet Yasin TEKE

Keyword(s):

Retinitis Pigmentosa ◽

Macular Hole ◽

Lamellar Macular Hole

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Optical coherence tomography-based consensus definition for lamellar macular hole

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-315432 ◽

2020 ◽

Vol 104 (12) ◽

pp. 1741-1747 ◽

Cited By ~ 8

Author(s):

Jean Pierre Hubschman ◽

Andrea Govetto ◽

Richard F Spaide ◽

Ricarda Schumann ◽

David Steel ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Macular Hole ◽

Retinal Thickness ◽

Future Research ◽

Lamellar Macular Hole ◽

Optical Coherence ◽

Consensus Definition ◽

Anatomical Features ◽

Apparent Loss ◽

Definition Of

BackgroundA consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed.MethodsThe panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions.ResultsThe panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle’s fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness.ConclusionsThe use of the proposed definitions may provide uniform language for clinicians and future research.

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Long-Term Outcome of Vitrectomy with Suitable Internal Limiting Membrane Peeling and Air Tamponade for Highly Myopic Foveoschisis-Associated Lamellar Macular Hole

Journal of Ophthalmology ◽

10.1155/2020/2074037 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Jia-lin Wang ◽

Yan-ling Wang

Keyword(s):

Macular Hole ◽

Internal Limiting Membrane ◽

Lamellar Macular Hole ◽

Ilm Peeling ◽

Long Term Outcome ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Myopic Foveoschisis ◽

Air Tamponade

Purpose. To investigate the outcome of pars plana vitrectomy (PPV) with suitable internal limiting membrane peeling (ILM) and air tamponade for patients with highly myopic foveoschisis-associated lamellar macular hole (MH). Methods. This retrospective interventional case series included 11 patients with highly myopic foveoschisis-associated lamellar MH who underwent PPV and indocyanine green-aided ILM peeling up to the temporal vascular arcades. Following air tamponade after surgery, all patients were instructed to maintain a face-down position. The patients were followed up for over 1 year and evaluated for MH closure and the best-corrected visual acuity before and after surgery. Results. The mean ± standard deviation values of patient age, axial length, and follow-up duration were 67.82 ± 6.54 years, 29.21 ± 1.95 mm, and 24.27 ± 8.11 months, respectively. After surgery, the lamellar MH closed in all eyes, and 10 eyes showed vision improvement at the 1-month, 3-month, and final follow-up evaluations. One patient showed decreased vision at 2 years after surgery, with patchy chorioretinal atrophy in the macular region. Myopic foveoschisis showed resolution in three eyes and alleviation in eight. Ten patients underwent cataract surgery during PPV. Conclusion. Extension of ILM peeling up to the temporal vascular arcades and air tamponade after PPV may improve the visual function and rate of MH closure for patients with highly myopic foveoschisis-associated lamellar MH.

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