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      The Management of Lamellar Macular Holes: A Review

      review-article
      Author(s): 1 , 2 , , 2
      Publication date (Electronic):
      Journal: Journal of Ophthalmology
      Publisher: Hindawi

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          Abstract

          This literature review aims to provide the retina specialist with answers to patient's questions related to the management of lamellar macular holes (LMHs). Most LMHs are stable over time, but 13–21% present an anatomic decline after 18–24 months of follow-up. Nineteen point five percent of the eyes may experience a visual acuity (VA) loss of more than 5 letters after 3 years. Many surgeons choose to perform surgery when there is significant metamorphopsia or documented decline in VA over time. The typical surgery is phacovitrectomy with the epiretinal membrane and the internal limiting membrane peeling in previously phakic eyes (41.9 to 85.3% of the eyes). In the eyes that remained phakic, cataract surgery was often necessary within the first year of follow-up (19.2 to 40% of eyes). After surgery, a VA gain was recorded in 63–94% of eyes, but some eyes (between 0 and 20%) suffered some VA loss. Progression to full-thickness macular hole may occur after surgery, and thus a second surgical intervention may be needed.

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          The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole.

          Jay Duker, Peter K Kaiser, Susanne Binder … (2013)
          The International Vitreomacular Traction Study (IVTS) Group was convened to develop an optical coherence tomography (OCT)-based anatomic classification system for diseases of the vitreomacular interface (VMI).
          Article 0 comments Cited 313 times – based on 0 reviews     Review now
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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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              Epiretinal proliferation seen in association with lamellar macular holes: a distinct clinical entity.

              Richard Spaide, K. Bailey Freund, Claudine Pang (2014)
              To describe the prevalence and imaging characteristics of a distinct entity of epiretinal proliferation seen predominantly in association with lamellar macular holes (LMH), termed lamellar hole-associated epiretinal proliferation (LHEP).
              Article 0 comments Cited 67 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Horia Tudor Stanca:
                ORCID: https://orcid.org/0000-0003-2595-6319
                Journal
                Journal ID (nlm-ta): J Ophthalmol
                Journal ID (iso-abbrev): J Ophthalmol
                Journal ID (publisher-id): JOPH
                Title: Journal of Ophthalmology
                Publisher: Hindawi
                ISSN (Print): 2090-004X
                ISSN (Electronic): 2090-0058
                Publication date Collection: 2020
                Publication date (Electronic): 21 February 2020
                Volume: 2020
                Electronic Location Identifier: 3526316
                Affiliations
                1Department of Ophthalmology, “Gr. T. Popa” University of Medicine and Pharmacy, Iasi 700111, Romania
                2Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, Bucharest 020021, Romania
                Author notes

                Academic Editor: Michele Figus

                Author information
                https://orcid.org/0000-0002-1639-2921
                https://orcid.org/0000-0003-2595-6319
                Article
                DOI: 10.1155/2020/3526316
                PMC ID: 7054780
                SO-VID: fa64d4b0-3a5e-4422-9561-9e3b35ba2fca
                Copyright © Copyright © 2020 Ciprian Danielescu et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 4 November 2019
                Date revision received : 19 January 2020
                Date accepted : 31 January 2020
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Ophthalmology & Optometry
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry

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