Idiopathic Macular Hole without Vitreomacular Separation

Purpose: To investigate the clinical features and treatment outcomes of idiopathic full thickness macular hole (FTMH) without vitreomacular separation (VMS). Methods: Consecutive cases of idiopathic FTMH at one tertiary center from January 2013 to April 2020 was retrospectively recruited. They were separated into two groups according to the findings in optical coherence tomography (OCT): FTMH with VMS and FTMH without VMS. Ophthalmic examinations and OCT were performed pre and postoperatively. The clinical findings were compared between two groups. Results: Of the total 124 cases, 15 (12.1 %) were noted as FTMH without VMS with the presence of an attached posterior hyaloid (PH) at macula. The macular hole (MH) size was smaller (276.06 ± 170.10 µm) compared to those with VMS (492.83 ± 209.31 µm) (P < 0.001). The incidence of lamellar hole associated epiretinal proliferation (LHEP) was much higher in this group (13/15, 86.7%), compared to FTMH with VMS (11/109, 10.1%) (P < 0.001). A higher rate of spontaneous closure of MH (13.3%) was also noted in FMTH without VMS (13.3% vs 0.9% in FTMH with VMS, P = 0.040). After operation, the MH closure rate was 93.3%. The postoperative best-corrected visual acuity was not significantly different between two groups (P = 0.098). Conclusions: A small percentage (12.1% in this series) of idiopathic FTMH had no VMS. The completely attached PH along with the high incidence of LHEP implied a tangential traction in FTMH without VMS. The MH size was usually small, and the postoperative outcomes was similar to those of conventional FTMH with VMS.

Lamellar Hole-associated Epiretinal Proliferation in choroideremia: a case report

Background To report a clinical case of a patient affected with choroideremia (CHM) who underwent macular surgery for a macular hole (MH) with Lamellar Hole-associated Epiretinal Proliferation (LHEP). Case presentation We have described a 48-year-old male patient affected with CHM who developed MH with LHEP over a 7-year follow-up. The patient was referred to the Regional Center for Hereditary Retinal Degenerations of the Eye Clinic in Florence (Italy) in April 2012. The patient underwent vitrectomy and Inner Limiting Membrane (ILM) and LHEP peeling with fluid-air exchange. Ultra-structural examination of the excised epiretinal proliferation, carried out using electron microscopy, showed dense amorphous material, mainly composed of abundant clusters of fibrous collagens resembling compact fibrous long spacing collagen (FLSC), embedded in native vitreous collagen (NVC) and type IV collagen. No cells were detected in any of the specimens collected. At the 3rd-week postoperative follow-up the macular hole was closed. Conclusion Macular hole with LHEP can be detected in CHM patients; in our patient the macular hole showed tractional and degenerative features, with good anatomical results after macular surgery.

Lamellar hole-associated epiretinal membrane in retinitis pigmentosa: a surgical correlation

Retinitis pigmentosa (RP) is a rare hereditary disease, yet it is the commonest cause of retinal dystrophy. Although lamellar hole-associated epiretinal membrane (LHEP) is commonly associated with macular holes, the development of macular holes in RP itself is rare. In this article, we report a rare case of bilateral LHEP in RP, and the surgical outcome of LHEP embedding and internal limiting membrane (ILM) flap in repairing a lamellar macular hole (LMH). A 57-year-old woman who had RP with bilateral LHEP underwent a combination of cataract and vitrectomy surgery in her left eye. We preserved LHEP tissue and performed an ILM flap to avoid a iatrogenic full-thickness macular hole (FTMH) and facilitate LMH closure. Her right eye was monitored conservatively. At 2 weeks postoperative, the LMH in her left eye was anatomically repaired. There was limited improvement of visual acuity, which could be justified by disruption of the junction between the photoreceptors’ inner and outer segments (IS/OS junction) as evidenced by spectral-domain optical coherence tomography (SD-OCT). The presence of LHEP in LMH is highly associated with disruption of the IS/OS junction and therefore patients should be counselled regarding guarded visual improvement post-vitrectomy. LHEP, which is derived from a Müller cell-driven process, is closely associated with LMH in RP, likely due to the progressive retinal tissue loss as a result from the disease nature of RP. Therefore, we suggest preserving LHEP tissue and performing an ILM flap as an improvised technique to avoid iatrogenic FTMH and facilitate LMH closure.

Surgery Outcomes of Lamellar Macular Eyes with or without Lamellar Hole-Associated Epiretinal Proliferation: A Meta-Analysis

Background: Given the two different kinds of epiretinal membranes, this study aimed to compare both the structural and functional outcomes of lamellar macular holes with and without lamellar hole-associated epiretinal proliferation (LHEP) after surgery.Method: Publications up to July 2020 that compared the surgical outcomes of lamellar macular hole with and without LHEP were included. Forest plots were created by using a weighted summary of proportion meta-analysis. Fixed or random effects models were used on the basis of I2 heterogeneity estimates. Meanwhile, to evaluate the stability of the meta-analysis, a sensitivity analysis was carried out.Results: Eight pertinent publications that contained a total of 176 eyes without LHEP and 173 eyes with LHEP were included. They were all retrospective studies and had a follow-up of at least 6 months. In all studies, the preoperative best corrected visual acuity showed no significant differences between the two groups, and the visual acuity improved in both groups after surgery. The pooled result for the improved best corrected visual acuity was 0.18 (95% confidence interval (CI), 0.10 to 0.26; P< 0.01) between the with and without LHEP groups. The restored ellipsoid zone odds ratio was 0.80 (95% CI, 0.26 to 2.44; P= 0.69) for the group with LHEP compared to the group without LHEP.Conclusion: Patients without LHEP had better postoperative visual acuity than patients with LHEP. No significant difference in restored ellipsoid zone was found between the two groups.

Surgery Outcomes of Lamellar Macular Eyes with or without Lamellar Hole-Associated Epiretinal Proliferation: A Meta-Analysis

Purpose: Given the two different kind of epiretinal membranes, this study aimed to compare both the structural and functional outcomes of lamellar macular hole (LMH) with and without lamellar hole-associated epiretinal proliferation (LHEP) after surgery. Method: Publications up to July 2020 that compared the surgical outcomes of LMH patients with and without LHEP were included. Forest plots were created by using a weighted summary of proportion meta-analysis. Fixed or random effects models were used based on I2 heterogeneity estimates. Meanwhile, to evaluate the stability of the meta-analysis, sensitivity analysis was carried out.Result: Eight pertinent publications were included, which contained a total of 176 eyes without LHEP and 173 eyes with LHEP. They were all retrospective studies and had a follow-up of at least 6 months. In all studies, the preoperative best corrected visual acuity (BCVA) had no significant differences between the two groups and improved in both groups after surgery. Pooled results of the improved BCVA was 0.18 (95 % CI, 0.10 to 0.26; P< 0.01) between the with and without LHEP groups. The odds ratio of restored ellipsoid zone (REZ) was 0.80 (95% CI, 0.26 to 2.44; p = 0.69) among the group with LHEP and without LHEP.In conclusion, patients without LHEP had better postoperative BCVA than patients with LHEP. No significant difference was found in REZ among the two groups.

Surgery Outcomes of Lamellar Macular Eyes with or without Lamellar Hole-Associated Epiretinal Proliferation: A Meta-Analysis

Purpose: This study aimed at comparing both the structural and functional outcomes of lamellar macular hole (LMH) with and without lamellar hole-associated epiretinal proliferation (LHEP) after surgery. Method: Publications up to July 2020 that compared the surgical outcomes of LMH patients with and without LHEP were included. Forest plots were created using a weighted summary of proportion meta-analysis. Fixed or random effects modes were used based on I2 heterogeneity estimates. To evaluate the stability of the meta-analysis, sensitivity analysis was carried out. Result: Eight pertinent publications containing a total of 176 eyes without LHEP and 173 eyes with LHEP were included. They were all retrospective studies and had a mean follow-up of at least 6 months. In all studies, the preoperative best corrected visual acuity (BCVA) had no significant differences between the two groups and BCVA improved in both groups after surgery. Pooled results of the improved BCVA was 0.18 (95 % CI, 0.10 to 0.26; P< 0.01) between with and without LHEP groups. However, the odd ratio of restored ellipsoid zone was 0.80 (95% CI, 0.26 to 2.44; p = 0.69) among the group with LHEP and the group without LHEP. In conclusion, patients without LHEP had better postoperative BCVA than patients with LHEP. No significant difference was found in REZ among the two groups. The necessity of surgery for patients with LHEP needs more studies to identify.

Surgery Outcomes of Lamellar Macular Eyes with or without Lamellar Hole-Associated Epiretinal Proliferation: A Meta-Analysis

Background: To compare the visual outcomes and rate of restored ellipsoid zone (REZ) after surgery of lamellar macular hole (LMH) with and without lamellar hole-associated epiretinal proliferation (LHEP). Method: Publications up to November 2019 that compared the outcomes of LMH patients with and without LHEP who were managed by surgery were included. Forest plots were created using a weighted summary of proportion meta-analysis. A random effects mode was used and I2 heterogeneity estimates were calculated. Sensitivity analysis was carried out to evaluate the stability of the meta-analysis. Result: Eight pertinent publications studying a total of 176 eyes without LHEP and 173 eyes with LHEP were identified. They were all retrospective studies and had a mean follow-up of at least 6 months. In all studies, the best corrected visual acuity (BCVA) had no significant differences before surgery and improved in both groups, and in two studies the post-operative BCVA had no significant differences between two groups. The rate of REZ were different among studies included. Meta-analytic pooling of the improved BCVA between with and without LHEP groups was 0.18 (95 % CI, 0.10 to 0.26; P< 0.01), and the pooled data revealed an odd ratio of 0.80 (95% CI, 0.26 to 2.44; p = 0.69) in the rate of REZ, comparing the group without LHEP and the group with LHEP. In conclusion, patients without LHEP had better postoperative BCVA than patients with LHEP. No significant difference was found in REZ among the two groups.