The clinical efficacy of lamellar hole-associated epiretinal proliferation flap insertion and autologous blood for degenerative type lamellar macular hole_Chinese Journal of Ocular Fundus Diseases

Authors：

Wu Yue , Hu Zhixiang , Hu Xuting , Li Fenfen , Lei Xiang ,  Song Zongming

Eye Hospital of Wenzhou Medical University, Wenzhou, 325027, China (Wu Yue, now working at Ningbo Eye Hospital; Lei Xiang, Song Zongming, now working at the Department of Ophthalmology, Henan Province People Hospital);

Corresponding author：

Song Zongming, Email: szmeyes@126.com

Keywords：

Retinal Perforations/surgery; Vitrectomy

DOI：

10.3760/cma.j.issn.1005-1015.2017.06.015

Video：

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Objective To observe the efficacy of lamellar hole-associated epiretinal proliferation (LHEP) flap insertion and autologous blood for degenerative type lamellar macular hole (LMH). Methods Retrospective case review. Twenty-eight eyes of 28 patients with LMH were enrolled in this study. There were 2 males (2 eyes) and 26 females (26 eyes). Best corrected visual acuity (BCVA), medical optometry, slit-lamp biomicroscop, indirect ophthalmoscope, spectral domain optical coherence tomography, b-scan ultrasonography and axial length detection were performed on all patients. Logarithm of the minimum angle of resolution (logMAR) was used to calculate visual acuity. There were 10 eyes (35.7%) with degenerative type LMH (flap insertion group) and LHEP. There were 18 eyes (64.3%) with tractional type LMH (general group). The differences of BCVA, AL, horizontal hole diameter from retina and lens state between two groups were not significant (P＞0.05). The differences of horizontal hole diameter of internal limiting membrane (ILM), central foveal thickness (CFT) and integrity of ellipsoidal zone between two groups were significant (P＜0.05). LHEP flap insertion and autologous blood without ILM peeling were used in eyes of flap insertion group. Vitrectomy combined ILM peeling were used in eyes of general group. The follow-up was ranged from 3 to 14 months. The changes of CFT, central foveal form and logMAR BCVA were observed. Results At latest follow-up, the BCVA of flap insertion group and general group were 0.34±0.27, 0.31±0.29; which significantly better than the preoperative BCVA (Z=−3.519, −4.945; P＜0.001). The CFT of flap insertion group and general group were (200.10±58.78), (226.61±70.49) μm. There was no difference between pre- and post-operative CFT in eyes of general group (Z=−1.455, P=0.146). There was significant difference between pre- and post-operative CFT in eyes of flap insertion group (Z=−2.798, P=0.005). In flap insertion group, regular recovery of the foveal contour occurred in 9 eyes (90.0%), improvement in 1 eyes (10.0%). In general group, regular recovery of the foveal contour occurred in 10 eyes (55.6%), improvement in 8 eyes (44.4%). The closure rate of LMH were 100% both in two groups. Conclusion LHEP flap insertion and autologous blood is an effective treatment of degenerative type LMH.

Citation： Wu Yue, Hu Zhixiang, Hu Xuting, Li Fenfen, Lei Xiang, Song Zongming. The clinical efficacy of lamellar hole-associated epiretinal proliferation flap insertion and autologous blood for degenerative type lamellar macular hole. Chinese Journal of Ocular Fundus Diseases, 2017, 33(6): 616-620. doi: 10.3760/cma.j.issn.1005-1015.2017.06.015 Copy

1.	Govetto A, Dacquay Y, Farajzadeh M, et al. Lamellar macular hole: two distinct clinical entities? [J].Am J Ophthalmol, 2016, 164: 99-109.DOI:10.1016/j.ajo.2016.02.008.
2.	Pang CE, Spaide RF, Freund KB,et al. Comparing functional and morphologic characteristics of lamellar macular holes with and without lamellar hole-associated epiretinal proliferation[J]. Retina, 2015, 35(4): 720-726. DOI: 10.1097/IAE.0000000000000390.
3.	Bottoni F, Deiro AP, Giani A, et al. The natural history of lamellar macular holes: a spectral domain optical coherence tomography study[J]. Graefe’s Arch Clin Exp Ophthalmol, 2013, 251 (2): 467-475. DOI: 10.1007/s00417-012-2044-2.
4.	Smiddy WE, Maguire AM, Green WR, et al. Idiopathic epiretinal membranes: ultrastructural characteristics and clinicopathologic correlation[J]. Ophthalmology, 1989, 96(6): 811-821. DOI: 10.1016/S0161-6420(89)32811-9.
5.	Clarkson JG, Green WR, Massof D. A histopathologic review of 168 cases of preretinal membranes[J]. Am J Ophthalmol, 1977, 84(1): 1-17.
6.	Bringmann A, Wiedemann P. Involvement of Muller glial cells in epiretinal membrane formation[J]. Graefe’s Arch Clin Exp Ophthalmol, 2009, 247(7): 865-883. DOI: 10.1007/s00417-009-1082-x.
7.	Ko J, Kim GA, Lee SC, et al. Surgical outcomes of lamellar macular holes with and without lamellar hole-associated epiretinal proliferation[J]. Acta Ophthalmol, 2017, 95(3): 221-226. DOI: 10.1111/aos.13245.
8.	Korobelnik JF, Hannouche D, Belayachi N, et al. Autologous platelet concentrate as an adjunct in macular hole healing: a pilot study[J]. Ophthalmology, 1996, 103(4): 590-594. DOI: 10.1016/S0161-6420(96)30648-9.
9.	Liggett PE, Skolik DS, Horio B, et al. Human autologous serum for the treatment of full-thickness macular holes:a preliminary study[J]. Ophthalmology, 1995, 102(7): 1071-1076. DOI: 10.1016/S0161-6420(95)30909-8.
10.	Witkin AJ, Ko TH, Fujimoto JG, et al. Redefining lamellar holes and the vitreomacular interface: an ultrahigh-resolution optical coherence tomography study[J]. Ophthalmology, 2006, 113(3): 388-397. DOI:10.1016/j.ophtha.2005.10.047.
11.	Duker JS, Kaiser PK, Binder S, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole[J]. Ophthalmology, 2013, 120(12): 2611-2619. DOI: 10.1016/j.ophtha.2013.07.042.
12.	Reibaldi M, Parravano M, Varano M, et al. Foveal microstructure and functional parameters in lamellar macular hole[J]. Am J Ophthalmol, 2012, 154(6): 974-980. DOI:10.1016/j.ajo.2012.06.008.
13.	Hirakawa M, Uemura A, Nakano T,et al. Pars plana vitrectomy with gas tamponade for lamellar macular holes[J]. Am J Ophthalmol,2005,140(6):1154-1155.DOI:10.1016/j.ajo.2005.07.022.
14.	Kokame GT, Tokuhara KG. Surgical management of inner lamellar hole[J]. Ophthalmic Surg Lasers Imaging, 2007,38(1):61-63.
15.	Eagler C, Schaal KB, Hoh AE, et al. Surgical treatment of lamellar hole[J]. Ophthalmologe, 2008,105(9):836-839. DOI: 10.1007/s00347-008-1765-4.
16.	Garretson BR, Pollack JS, Ruby AJ, et al. Vitrectomy for a symptomatic lamellar macular hole[J]. Ophthalmology, 2008, 115 (5):884-886.DOI:10.1016/j.ophtha.2007.06.029.
17.	Micalewska Z, Michalewski J, Odrobina D, et al. Surgical treatment of lamellar macular holes [J]. Graefe’s Arch Clin Exp Ophthalmol, 2010, 248(10): 1395-1400. DOI: 10.1007/s00417-010-1400-3.
18.	Figueroa MS, Noval S, Contreras I.Macular structure on optical coherence tomography after lamellar macular hole surgery and its correlation with visual outcome[J]. Can J Ophthalmol, 2011, 46(6): 491-497. DOI: 10.1016/j.jcjo.2011.09.011.
19.	Shiraga F, Takasu I, Fukuda K, et al. Modified vitreous surgery for symptomatic lamellar macular hole with epiretinal membrane containing macular pigment[J].Retina, 2013, 33(6): 1263-1269. DOI: 10.1097/IAE.0b013e31828bcb61.
20.	Beatty S, Koh H, Phil M, et al. The role of oxidative stress in the pathogenesis of age-related macular degeneration[J]. Surv Ophthalmol, 2000, 45(2): 115-134. DOI: 10.1016/S0039-6257(00)00140-5.
21.	Terasaki H, Miyake Y, Nomura R, et al. Focal macular ERGs in eyes after removal of macular ILM during macular hole surgery[J]. Invest Ophthalmol Vis Sci, 2001, 42: 229-234.

1. Govetto A, Dacquay Y, Farajzadeh M, et al. Lamellar macular hole: two distinct clinical entities? [J].Am J Ophthalmol, 2016, 164: 99-109.DOI:10.1016/j.ajo.2016.02.008.
2. Pang CE, Spaide RF, Freund KB,et al. Comparing functional and morphologic characteristics of lamellar macular holes with and without lamellar hole-associated epiretinal proliferation[J]. Retina, 2015, 35(4): 720-726. DOI: 10.1097/IAE.0000000000000390.
3. Bottoni F, Deiro AP, Giani A, et al. The natural history of lamellar macular holes: a spectral domain optical coherence tomography study[J]. Graefe’s Arch Clin Exp Ophthalmol, 2013, 251 (2): 467-475. DOI: 10.1007/s00417-012-2044-2.
4. Smiddy WE, Maguire AM, Green WR, et al. Idiopathic epiretinal membranes: ultrastructural characteristics and clinicopathologic correlation[J]. Ophthalmology, 1989, 96(6): 811-821. DOI: 10.1016/S0161-6420(89)32811-9.
5. Clarkson JG, Green WR, Massof D. A histopathologic review of 168 cases of preretinal membranes[J]. Am J Ophthalmol, 1977, 84(1): 1-17.
6. Bringmann A, Wiedemann P. Involvement of Muller glial cells in epiretinal membrane formation[J]. Graefe’s Arch Clin Exp Ophthalmol, 2009, 247(7): 865-883. DOI: 10.1007/s00417-009-1082-x.
7. Ko J, Kim GA, Lee SC, et al. Surgical outcomes of lamellar macular holes with and without lamellar hole-associated epiretinal proliferation[J]. Acta Ophthalmol, 2017, 95(3): 221-226. DOI: 10.1111/aos.13245.
8. Korobelnik JF, Hannouche D, Belayachi N, et al. Autologous platelet concentrate as an adjunct in macular hole healing: a pilot study[J]. Ophthalmology, 1996, 103(4): 590-594. DOI: 10.1016/S0161-6420(96)30648-9.
9. Liggett PE, Skolik DS, Horio B, et al. Human autologous serum for the treatment of full-thickness macular holes:a preliminary study[J]. Ophthalmology, 1995, 102(7): 1071-1076. DOI: 10.1016/S0161-6420(95)30909-8.
10. Witkin AJ, Ko TH, Fujimoto JG, et al. Redefining lamellar holes and the vitreomacular interface: an ultrahigh-resolution optical coherence tomography study[J]. Ophthalmology, 2006, 113(3): 388-397. DOI:10.1016/j.ophtha.2005.10.047.
11. Duker JS, Kaiser PK, Binder S, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole[J]. Ophthalmology, 2013, 120(12): 2611-2619. DOI: 10.1016/j.ophtha.2013.07.042.
12. Reibaldi M, Parravano M, Varano M, et al. Foveal microstructure and functional parameters in lamellar macular hole[J]. Am J Ophthalmol, 2012, 154(6): 974-980. DOI:10.1016/j.ajo.2012.06.008.
13. Hirakawa M, Uemura A, Nakano T,et al. Pars plana vitrectomy with gas tamponade for lamellar macular holes[J]. Am J Ophthalmol,2005,140(6):1154-1155.DOI:10.1016/j.ajo.2005.07.022.
14. Kokame GT, Tokuhara KG. Surgical management of inner lamellar hole[J]. Ophthalmic Surg Lasers Imaging, 2007,38(1):61-63.
15. Eagler C, Schaal KB, Hoh AE, et al. Surgical treatment of lamellar hole[J]. Ophthalmologe, 2008,105(9):836-839. DOI: 10.1007/s00347-008-1765-4.
16. Garretson BR, Pollack JS, Ruby AJ, et al. Vitrectomy for a symptomatic lamellar macular hole[J]. Ophthalmology, 2008, 115 (5):884-886.DOI:10.1016/j.ophtha.2007.06.029.
17. Micalewska Z, Michalewski J, Odrobina D, et al. Surgical treatment of lamellar macular holes [J]. Graefe’s Arch Clin Exp Ophthalmol, 2010, 248(10): 1395-1400. DOI: 10.1007/s00417-010-1400-3.
18. Figueroa MS, Noval S, Contreras I.Macular structure on optical coherence tomography after lamellar macular hole surgery and its correlation with visual outcome[J]. Can J Ophthalmol, 2011, 46(6): 491-497. DOI: 10.1016/j.jcjo.2011.09.011.
19. Shiraga F, Takasu I, Fukuda K, et al. Modified vitreous surgery for symptomatic lamellar macular hole with epiretinal membrane containing macular pigment[J].Retina, 2013, 33(6): 1263-1269. DOI: 10.1097/IAE.0b013e31828bcb61.
20. Beatty S, Koh H, Phil M, et al. The role of oxidative stress in the pathogenesis of age-related macular degeneration[J]. Surv Ophthalmol, 2000, 45(2): 115-134. DOI: 10.1016/S0039-6257(00)00140-5.
21. Terasaki H, Miyake Y, Nomura R, et al. Focal macular ERGs in eyes after removal of macular ILM during macular hole surgery[J]. Invest Ophthalmol Vis Sci, 2001, 42: 229-234.

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The clinical efficacy of lamellar hole-associated epiretinal proliferation flap insertion and autologous blood for degenerative type lamellar macular hole

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