Clinical Ophthalmology (Jun 2022)

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

  • Haave H,
  • Petrovski BÉ,
  • Zając M,
  • Lumi X,
  • Melekidou W,
  • Lytvynchuk L,
  • Ruban A,
  • Znaor L,
  • Nawrocki J,
  • Nawrocka ZA,
  • Petrovski G

Journal volume & issue
Vol. Volume 16
pp. 1847 – 1860

Abstract

Read online

Hanna Haave,1,* Beáta Éva Petrovski,1,* Michał Zając,2 Xhevat Lumi,3 Wassiliki Melekidou,4 Lyubomyr Lytvynchuk,4,5 Andrii Ruban,6 Ljubo Znaor,7,8 Jerzy Nawrocki,2 Zofia Anna Nawrocka,2,* Goran Petrovski1,9,* 1Department of Ophthalmology, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; 2Ophthalmic Clinic “Jasne Blonia”, Lodz, Poland; 3Eye Hospital, University Medical Centre, Ljubljana, Slovenia; 4Department of Ophthalmology, Justus Liebig University, University Hospital Giessen and Marburg GmbH, Giessen, Germany; 5Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria; 6Center of Clinical Ophthalmology, Kyiv, Ukraine; 7Department of Ophthalmology, University of Split School of Medicine, Split, Croatia; 8Department of Ophthalmology, University Hospital Centre, Split, Croatia; 9Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Oslo, Norway*These authors contributed equally to this workCorrespondence: Goran Petrovski, Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, Oslo, 0450, Norway, Tel +47 2301 5163, Email [email protected]: 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: lamellar macular hole, surgical outcomes, tractional, degenerative, BCVA, OCT

Keywords