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      Surgical Management of Full-Thickness Macular Holes Spontaneously Arising From Lamellar Macular Holes

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          Abstract

          Introduction: To review the literature regarding surgical management of full-thickness macular holes (FTMHs) spontaneously arising from lamellar MHs (LMHs). Methods: The literature on surgically managed FTMHs arising from LMHs was reviewed via Ovid MEDLINE and Embase through June 5, 2022. Results: Seventy-six eyes from 16 articles were included. Forty eyes had internal limiting membrane (ILM) peeling, 32 inverted ILM flap techniques, and 4 an unclear surgical technique. The FTMH closure rate was not significantly different between ILM peeling (34/40 [85%]) and the inverted ILM flap techniques (28/32 [88%]) ( P = .761). The mean (±SD) logMAR visual acuity improved from 0.64 ± 0.46 to 0.25 ± 0.22 (Snellen 20/87 to 20/36) with ILM peeling (n = 30); similar data were not available for inverted ILM flap techniques. Conclusions: Foveal tissue loss, flat hole edges, and limited retinal hydration may result in inverted ILM flap techniques having outcomes similar to those of ILM peeling in repairing FTMHs from LMHs. Future studies are needed to compare techniques.

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          Redefining lamellar holes and the vitreomacular interface: an ultrahigh-resolution optical coherence tomography study.

          Andre J. Witkin, Tony Ko, James Fujimoto … (2006)
          To define optical coherence tomographic (OCT) criteria for the diagnosis of a lamellar macular hole, and to increase understanding of lamellar hole pathogenesis by examining fine anatomic features using ultrahigh-resolution optical coherence tomography (UHR OCT). Retrospective observational case series. Nineteen eyes of 18 patients with lamellar holes were imaged with UHR OCT between 2002 and 2004. A UHR OCT system was developed for use in the ophthalmology clinic. All 6 UHR OCT images for each eye imaged were examined. Lamellar holes were diagnosed based on a characteristic OCT appearance. Criteria for the OCT diagnosis of a lamellar hole were as follows: (1) irregular foveal contour; (2) break in the inner fovea; (3) intraretinal split; and (4) intact foveal photoreceptors. From 1205 eyes of 664 patients imaged with UHR OCT, and retrospectively reviewed, 19 eyes of 18 patients were diagnosed with a lamellar hole based on these criteria. All 19 eyes were also imaged with standard resolution OCT. Their charts were retrospectively reviewed. Standard and ultrahigh-resolution OCT images. On chart review, clinical diagnosis of a lamellar hole was made in only 7 of 19 eyes (37%). Twelve of 19 eyes (63%) had an epiretinal membrane (ERM) on clinical examination. Ten of 19 eyes (53%) had a posterior vitreous detachment. On UHR OCT, 17 of 19 eyes (89%) had ERMs. Eleven ERMs had an unusual thick appearance on UHR OCT. Due to poor visual acuity, 4 eyes underwent vitrectomy. Only 1 of 4 surgeries (25%) was visually and anatomically successful. Another eye improved visually, but a lamellar hole persisted. One eye progressed to a full-thickness macular hole preoperatively, which reopened after surgery. One eye developed a full-thickness hole postoperatively. The diagnosis of a lamellar hole can be made based on OCT criteria, which could be applied to both standard and ultrahigh-resolution OCT. The increased resolution of UHR OCT sheds light on the pathogenesis of the lamellar hole. Epiretinal membranes were visualized on UHR OCT in the majority of eyes. Many ERMs had an unusual thick appearance on UHR OCT, which may represent either trapped vitreous or posterior hyaloid, and may help stabilize retinal anatomy. Conversely, ERM contraction may play a role in lamellar hole formation. Vitrectomy surgery was anatomically and visually successful in only 1 of 4 patients, suggesting caution when performing vitrectomy on lamellar holes.
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            Optical coherence tomography-based consensus definition for lamellar macular hole

            Jean Hubschman, Andrea Govetto, Richard Spaide … (2020)
            A consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed. The panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions. The 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. The use of the proposed definitions may provide uniform language for clinicians and future research.
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              Natural evolution from macular retinoschisis to full-thickness macular hole in highly myopic eyes.

              Zhi Liu, Q Xue, C. Sun … (2010)
              to evaluate the morphological changes that occurred during the development of a full-thickness macular hole (FTMH) from macular retinoschisis (MRS) in highly myopic eyes by optical coherence tomography (OCT). the clinical characteristics and OCT images of five eyes of five patients with myopic MRS who developed FTMH during the follow-up period were evaluated. the natural evolution from MRS to FTMH was classified into two patterns by OCT findings. In FTMH formation pattern 1, a focal area of the external retinal layer was elevated and followed by the development of a small outer lamellar macular hole (OLMH) and retinal detachment (RD). The OLMH and RD were then enlarged horizontally and elevated vertically until the OLMH was attached to the overlying retinal layer. A FTMH finally developed when the roof of RD opened. In FTMH formation pattern 2, the opening of the roof of MRS or cystoid space caused an inner lamellar macular hole (ILMH). The MRS was then gradually resolved except the residual MRS beneath the ILMH, the ILMH would finally proceed into a FTMH as long as the remained external retinal layer beneath the ILMH continued splitting posteriorly until it reached retinal epithelium pigment. our longitudinal study revealed two patterns of FTMH formation in highly myopic eyes with MRS. This finding might be useful in further understanding the pathogenesis of macular hole formation in high myopia.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Vitreoretin Dis
                Journal ID (iso-abbrev): J Vitreoretin Dis
                Journal ID (publisher-id): VRD
                Journal ID (hwp): spvrd
                Title: Journal of Vitreoretinal Diseases
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Print): 2474-1264
                ISSN (Electronic): 2474-1272
                Publication date (Electronic): 23 November 2023
                Publication date Collection: Jan-Feb 2024
                Publication date PMC-release: 23 November 2023
                Volume: 8
                Issue: 1
                Pages: 29-33
                Affiliations
                [1 ]Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, ON, Canada
                [2 ]Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
                [3 ]Kensington Vision and Research Centre, Toronto, ON, Canada
                Author notes
                [*]Peng Yan, MD, FRCSC, Kensington Vision and Research Centre, Ste 501, 340 College St, Toronto, ON M5T 3A9, Canada. Email: pyan@ 123456KensingtonHealth.org
                Author information
                https://orcid.org/0000-0002-9172-3049
                https://orcid.org/0000-0003-3818-9788
                Article
                Publisher ID: 10.1177_24741264231208493
                DOI: 10.1177/24741264231208493
                PMC ID: 10786080
                PubMed ID: 38223778
                SO-VID: 3367fb1a-bfc0-4e41-b5d9-77f830b9083d
                Copyright © © The Author(s) 2023
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Categories
                Subject: Original Manuscripts
                Custom metadata
                typesetter ts1
                cover-date January/February 2024

                Keywords: full-thickness macular hole,internal limiting membrane peeling,inverted internal limiting membrane flap,lamellar macular hole,macular hole
                Data availability:
                Keywords: full-thickness macular hole, internal limiting membrane peeling, inverted internal limiting membrane flap, lamellar macular hole, macular hole

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