Outcomes from the Retrospective Multicenter Cross-Sectional Study on Lamellar Macular Hole Surgery

Hanna Haave; Beáta Éva Petrovski; Michał Zając; Xhevat Lumi; Wassiliki Melekidou; Lyubomyr Lytvynchuk; Andrii Ruban; Ljubo Znaor; Jerzy Nawrocki; Zofia Anna Nawrocka; Goran Petrovski

doi:10.2147/OPTH.S351932

Outcomes from the Retrospective Multicenter Cross-Sectional Study on Lamellar Macular Hole Surgery

Clin Ophthalmol. 2022 Jun 8:16:1847-1860. doi: 10.2147/OPTH.S351932. eCollection 2022.

Authors

Hanna Haave^#¹, Beáta Éva Petrovski^#¹, Michał Zając², Xhevat Lumi³, Wassiliki Melekidou⁴, Lyubomyr Lytvynchuk^{4

5}, Andrii Ruban⁶, Ljubo Znaor^{7

8}, Jerzy Nawrocki², Zofia Anna Nawrocka^#², Goran Petrovski^#^{1

9}

Affiliations

¹ Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
² Ophthalmic Clinic "Jasne Blonia", Lodz, Poland.
³ Eye Hospital, University Medical Centre, Ljubljana, Slovenia.
⁴ Department of Ophthalmology, Justus Liebig University, University Hospital Giessen and Marburg GmbH, Giessen, Germany.
⁵ Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria.
⁶ Center of Clinical Ophthalmology, Kyiv, Ukraine.
⁷ Department of Ophthalmology, University of Split School of Medicine, Split, Croatia.
⁸ Department of Ophthalmology, University Hospital Centre, Split, Croatia.
⁹ Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.

^# Contributed equally.

Abstract

Purpose: To analyze the functional and anatomical parameters of lamellar macular hole (LMH) surgery with internal limiting membrane peeling and determine which surgical technique provides the best visual outcome.

Methods: This is a retrospective multicenter cross-sectional study on patients who underwent pars plana vitrectomy (PPV) for LMH with or without combined phaco-vitrectomy, as well as gas-, air- or BSS-tamponade. Pre- and postoperative examination included best corrected visual acuity (BCVA) measurements for functional comparison and optical coherence tomography (OCT) scans to determine the contributing anatomical parameters.

Results: A total of 66 consecutive patients were included (age: 71.79 ± 8.52 years), of which 47 (71.2%) were diagnosed as tractional type LMH, and 19 patients (28.8%) as degenerative type. An epiretinal membrane (ERM) was present in 63 of the patients (95.5%), LMH-associated epiretinal proliferation (LHEP) was present in 19 patients (28.8%), and 16 patients (24.2%) had concomitant ERM and LHEP. In the group of tractional LMH, the mean central foveal thickness (CFT) was 81.1% thicker (P < 0.05) than in the degenerative group. Thirty-one patients (47.0%) underwent a combined phaco-vitrectomy procedure, while the rest underwent 23G, 25G or 27G PPV. Seventeen of the 66 patients received gas-tamponade (25.7%)-either SF₆ or C₃F₈, 26 received air-tamponade (39.4%), while the remaining 23 patients received balanced salt solution (BSS)-tamponade (34.9%) during vitrectomy. The total BCVA showed significant improvement postoperatively (p < 0.001) and accordingly in the following groups: tractional LMH type (p < 0.001), degenerative type (p < 0.001), simple PPV (p < 0.001), phaco-vitrectomy (p < 0.001), BSS injection (p < 0.01), gas-tamponade (p < 0.05). None of the patients included in the study developed a full thickness macular hole postoperatively.

Conclusion: PPV provided a high success rate and functional improvement for treating LMH for both tractional and degenerative types, as well as combined phaco-vitrectomy treatment when cataract was present.

Keywords: BCVA; OCT; degenerative; lamellar macular hole; surgical outcomes; tractional.