Changes of retinal microstructure in lamellar macular hole after vitrectomy_Chinese Journal of Ocular Fundus Diseases

Authors：

Li Mengyang ,  Qu Jinfeng , Han Xinyao , Yao Yuou , Zhang Hui , Jin Enzhong , Hu Jie , Wang Zongyi , Zhao Mingwei

Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing 100044, China;

Corresponding author：

Qu Jinfeng, Email: drbari@163.com

Keywords：

Retinal perforations/surgery; Vitrectomy; Tomography optical coherence

DOI：

10.3760/cma.j.issn.1005-1015.2019.06.003

Video：

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Objective To observe the changes of retinal microstructure in lamellar macular hole (LMH) after vitrectomy.Methods A retrospective clinical observational study. Forty patients (41 eyes) with LMH and received vitrectomy in Ophthalmology Department of Peking University People’s Hospital from January 2014 to September 2018 were included in this study. Among them, 14 patients (15 eyes) were males and 26 patients (26 eyes) were females, with an average age of 67.8±8.6 years. There were 37 eyes with a lens and 4 eyes with an IOL. There were 29 eyes with LMH of tractional type, 7 eyes of degenerative type, and 5 eyes of mixed type. All patients underwent BCVA and OCT examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The average logMAR BCVA was 0.57±0.27; the mean macular retinal thickness (CRT) was 192.3±108.9 μm, the mean macular thickness (MRT) was 427.5±110.2 μm. Among the 29 eyes of tractional type, there were 17 eyes with retinal cavity, 8 eyes with macular retinoschisis, and 3 eyes with incomplete ellipsoid zone. Among the 7 eyes of degenerative type, there were 5 eyes with lamellar hole-associated epiretinal proliferation (LHEP), 5 eyes with retinal cavity, and 5 eyes with incomplete ellipsoid zone. Among the 5 eyes of mixed type, 2 eyes with LHEP, 1 eye with macular epiretinal membrane, and 4 eyes with incomplete ellipsoid zone. The average follow-up time after surgery was 12.8±5.2 months. Among them, 10 eyes were followed up for equal or greater than 24 months. After the surgery, the same equipment and method before the surgery were used for relevant examination. The changes of BCVA, CRT, and MRT before and after surgery were observed. Continuous variables were compared by t test.Results At the last follow-up, the mean logMAR BCVA was 0.37±0.26. Compared with before surgery, the difference was statistically significant (t=5.98, P＜0.01). The mean CRT and MRT were (245.2±90.8) and (347.0±46.7) μm, respectively. Compared with before surgery, the differences were statistically significant (t=-2.49, -5.24; P＜0.05, ＜0.01). CRT and MRT changed greatly within 6 months after surgery, and then tended to be gentle. Among the 3 eyes with incomplete ellipsoid zone of tractional type before surgery, ellipsoid zone recovered in 2 eyes and partially recovered in 1 eye. Among the 17 eyes with retinal cavity and 8 eyes with macular retinoschisis before surgery, there were still 4 eyes with retinal cavity, but all the retinoschisis were disappeared. Among the 5 eyes with retinal cavity of degenerative type before surgery, there were still 2 eyes with retinal cavity and all the eyes with incomplete ellipsoid zone. Among 10 eyes with a follow-up time of equal or greater than 24 months, the macular ganglion cell complex partially atrophied in 6 eyes, and the nerve fiber layer separated in 2 eyes. There was no full-thickness macular hole after surgery.Conclusion For most LMH patients, vitrectomy can effectively improve the visual acuity and promote the recovery of retinal microstructure.

Citation： Li Mengyang, Qu Jinfeng, Han Xinyao, Yao Yuou, Zhang Hui, Jin Enzhong, Hu Jie, Wang Zongyi, Zhao Mingwei. Changes of retinal microstructure in lamellar macular hole after vitrectomy. Chinese Journal of Ocular Fundus Diseases, 2019, 35(6): 534-538. doi: 10.3760/cma.j.issn.1005-1015.2019.06.003 Copy

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2.	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.
3.	Pang CE, Spaide RF, Freund KB. Epiretinal proliferation seen in association with lamellar macular holes: a distinct clinical entity[J]. Retina, 2014, 34(8): 1513-1523. DOI: 10.1097/IAE.0000000000000163.
4.	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.
5.	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.
6.	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.
7.	Chung H, Lee K, Hwang DJ, et al. Prediction of morphologic deterioration in patients with lamellar macular holes[J]. Retina, 2016, 36(9): 1699-1706. DOI: 10.1097/IAE.0000000000000997.
8.	Coassin M, Mastrofilippo V, Stewart JM, et al. Lamellar macular holes: surgical outcome of 106 patients with long-term follow-up[J]. Graefe’s Arch Clin Exp Ophthalmol, 2018, 256(7): 1265-1273. DOI: 10.1007/s00417-018-3989-6.
9.	Purtskhvanidze K, Balken L, Hamann T, et al. Long-term follow-up of lamellar macular holes and pseudoholes over at least 5 years[J]. Graefe’s Arch Clin Exp Ophthalmol, 2018, 256(6): 1067-1078. DOI: 10.1007/s00417-018-3972-2.
10.	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.
11.	Pang CE, Spaide RF, Freund KB. 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.
12.	Schumann RG, Compera D, Schaumberger MM, et al. Epiretinal membrane characteristics correlate with photoreceptor layer defects in lamellar macular holes and macular pseudoholes[J]. Retina, 2015, 35(4): 727-735. DOI: 10.1097/IAE.0000000000000375.
13.	Sun JP, Chen SN, Chuang CC, et al. Surgical treatment of lamellar macular hole secondary to epiretinal membrane[J]. Graefe’s Arch Clin Exp Ophthalmol, 2013, 251(12): 2681-2688. DOI: 10.1007/s00417-013-2364-x.
14.	Papadopoulou D, Donati G, Mangioris G, et ak. Anatomical and functional results of lamellar macular holes surgery[J]. Klin Monbl Augenheilkd, 2016, 233(4): 441-443. DOI: 10.1055/s-0041-111822.
15.	Spaide RF. "Dissociated optic nerve fiber layer appearance" after internal limiting membrane removal is inner retinal dimpling[J]. Retina, 2012, 32(9): 1719-1726. DOI: 10.1097/IAE.0b013e3182671191.
16.	Runkle AP, Srivastava SK, Yuan A, et al. Factors associated with development of dissociated optic nerve fiber layer appearance in the pioneer intraoperative optical coherence tomography study[J]. Retina, 2018, 38(Suppl 1): S103-109. DOI: 10.1097/IAE.0000000000002017.
17.	Morescalchi F, Russo A, Gambicorti E, et al. Peeling of the internal limiting membrane with foveal sparing for treatment of degenerative lamellar macular hole[J/OL]. Retina, 2019, 2019: E1 [2019-05-16]. https://insights.ovid.com/crossref?an=00006982-900000000-96130. DOI: 10.1097/IAE.0000000000002559.[published online ahead of print].

1. Gass JD. Lamellar macular hole: a complication of cystoid macular edema after cataract extraction[J]. Arch Ophthalmol, 1976, 94(5): 793-800. DOI: 10.1001/archopht.1976.03910030391008.
2. 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.
3. Pang CE, Spaide RF, Freund KB. Epiretinal proliferation seen in association with lamellar macular holes: a distinct clinical entity[J]. Retina, 2014, 34(8): 1513-1523. DOI: 10.1097/IAE.0000000000000163.
4. 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.
5. 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.
6. 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.
7. Chung H, Lee K, Hwang DJ, et al. Prediction of morphologic deterioration in patients with lamellar macular holes[J]. Retina, 2016, 36(9): 1699-1706. DOI: 10.1097/IAE.0000000000000997.
8. Coassin M, Mastrofilippo V, Stewart JM, et al. Lamellar macular holes: surgical outcome of 106 patients with long-term follow-up[J]. Graefe’s Arch Clin Exp Ophthalmol, 2018, 256(7): 1265-1273. DOI: 10.1007/s00417-018-3989-6.
9. Purtskhvanidze K, Balken L, Hamann T, et al. Long-term follow-up of lamellar macular holes and pseudoholes over at least 5 years[J]. Graefe’s Arch Clin Exp Ophthalmol, 2018, 256(6): 1067-1078. DOI: 10.1007/s00417-018-3972-2.
10. 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.
11. Pang CE, Spaide RF, Freund KB. 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.
12. Schumann RG, Compera D, Schaumberger MM, et al. Epiretinal membrane characteristics correlate with photoreceptor layer defects in lamellar macular holes and macular pseudoholes[J]. Retina, 2015, 35(4): 727-735. DOI: 10.1097/IAE.0000000000000375.
13. Sun JP, Chen SN, Chuang CC, et al. Surgical treatment of lamellar macular hole secondary to epiretinal membrane[J]. Graefe’s Arch Clin Exp Ophthalmol, 2013, 251(12): 2681-2688. DOI: 10.1007/s00417-013-2364-x.
14. Papadopoulou D, Donati G, Mangioris G, et ak. Anatomical and functional results of lamellar macular holes surgery[J]. Klin Monbl Augenheilkd, 2016, 233(4): 441-443. DOI: 10.1055/s-0041-111822.
15. Spaide RF. "Dissociated optic nerve fiber layer appearance" after internal limiting membrane removal is inner retinal dimpling[J]. Retina, 2012, 32(9): 1719-1726. DOI: 10.1097/IAE.0b013e3182671191.
16. Runkle AP, Srivastava SK, Yuan A, et al. Factors associated with development of dissociated optic nerve fiber layer appearance in the pioneer intraoperative optical coherence tomography study[J]. Retina, 2018, 38(Suppl 1): S103-109. DOI: 10.1097/IAE.0000000000002017.
17. Morescalchi F, Russo A, Gambicorti E, et al. Peeling of the internal limiting membrane with foveal sparing for treatment of degenerative lamellar macular hole[J/OL]. Retina, 2019, 2019: E1 [2019-05-16]. https://insights.ovid.com/crossref?an=00006982-900000000-96130. DOI: 10.1097/IAE.0000000000002559.[published online ahead of print].

Chinese Journal of Ocular Fundus Diseases

Changes of retinal microstructure in lamellar macular hole after vitrectomy

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