Vitrectomy For Lamellar Macular Hole: Prognostic Factors And Surgical Outcomes

1. Angie Fong¹
2. Wai Man Chan²

¹Queen Mary Hospital, Hong Kong S.A.R.
²Hong Kong Sanitorium Hospital, Hong Kong S.A.R.

Purpose: To investigate the anatomic and functional outcomes after pars plana vitrectomy, membrane peeling with gas tamponade for lamellar macular holes, and to investigate the prognostic factors affecting visual outcome. Design: Retrospective interventional case series

Methods: All cases of lamellar macular hole were identified by optical coherence tomography (OCT), which underwent 23 or 25 gauge pars plana vitrectomy with membrane peeling and gas temponade with or without cataract surgery. Pre and post-operative best corrected visual acuities (BCVA) were reviewed, and central foveal thickness and volumes were recorded from OCT scans. Visual symptoms were obtained by telephone interviews.

Results: 18 eyes were identified. 8 (44%) underwent concurrent cataract operation. There were significant improvement in overall visual acuities, with mean preoperative and postoperative logMAR BCVA being 0.37+/- 0.27 and 0.19 +/- 0.15 respectively (p=0.009). For the group that did not undergo cataract surgery, logMAR BCVA improved from 0.38+/- 0.28 to 0.19+/- 0.14 (p=0.05). All cases (100%) had closure of the internal retinal defect that were confirmed by OCT.
The average central foveal thickness was reduced from 343.6µm to 301.2µm (p=0.04). 63.6% and 70% of the cases experienced improvement in subjective blurring of vision and metamorphopsia respectively. Pearson correlation showed preoperative logMAR BCVA (r=0.84, p<0.001) and minimum foveal thickness ( r=0.54, p=0.04) to be positively correlated to improvement in VA.

Conclusions: This retrospective series suggests treatment with vitrectomy, membrane peeling and gas temponade for lamellar holes with poor presenting visual acuity and foveal thickening may lead to greater improvement in visual outcome.