Abstract

SA.19.08

Surgical treatment of lamellar macular hole

Engler C., Schaal K. B., Höh A. E., Dithmar S.
Department of Ophthalmology, University of Heidelberg

Objective: Pathogenesis of lamellar macular holes is not completely understood so far. Without treatment development of full-thickness macular holes is possible. Since there is no gold standard for lamellar macular hole treatment, evaluation of vitrectomy and peeling in patients with lamellar macular hole was performed regarding anatomical and functional outcome.
Methods: 10 patients with lamellar macular hole underwent vitrectomy, peeling (ERM/ILM) and gas- or silicone oil (n=1) endotamponade. Silicone oil had been removed by the time of follow-up examination. In most patients (n=9) cataract surgery was also performed. Pre- and postoperative OCT findings, visual acuity and Birkhaeuser near visual acuity were evaluated.
Results: Follow-up was at least 6 months, mean follow-up 15±11 months after surgery. BCVA improved in all patients, the average gain of BCVA was 3 ± 2 lines. Preoperative mean BCVA was 0.35 (0.45logMAR±0.23) and postoperative BCVA 0.64 (0.19logMAR±0.21). 80% had a postoperative BCVA³20/40, 60% a postoperative BCVA³20/25. Mean near visual acuity was 0.5±0.26 (range: 0.2-0.9). Postoperative OCT revealed a closed lamellar macular hole in 6 patients, with restored foveal contour in 3 of them. The other four patients showed a persistent inner retinal defect of different size with intact photoreceptor layer. In none of those patients we observed a progression of the retinal defect.
Conclusions: Surgical treatment including vitrectomy, peeling and endotamponade appears to be a beneficial treatment for patients with lamellar macular hole. All patients improved functionally, 60% had a postoperative BCVA³20/25. Surgical treatment can close the lamellar macular hole and restore the foveal architecture or prevent further progression of the retinal defect.

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