Surgical management of Lamellar macular holes: an up-to-date review

ABSTRACT

Introduction

Lamellar macular holes (LMHs) are a vitreoretinal disorder characterized by an absence of inner retinal layers at the foveal level and preservation of the photoreceptor layer.

Areas covered

Several authors have pointed out the stability of visual acuity over time in most cases of LMH, which makes surgery unnecessary. In contrast, numerous publications have shown that surgical treatment could be a valid therapeutic option in cases of lesions that progress over time, which is not so rare. The surgical techniques are not standardized yet, and although surgery is generally indicated following a reduction in visual acuity, metamorphopsia, or a progression of the retinal damage, the topic remains controversial. The purpose of this paper is to review and update current information about the surgical management of LMHs.

Expert opinion

Surgical techniques continue to improve in order to fulfil the quest for the best management of lamellar macular holes.

KEYWORDS:

• Lamellar macular holes
• lamellar hole epiretinal proliferation
• epiretinal membrane
• vitrectomy
• internal limiting membrane

Article highlights

• Lamellar macular hole might be subdivided in ‘tractional lamellar holes,’ occurring when a split appears between outer plexiform and outer nuclear layers associated with a thin and highly reflective ERM or vitreomacular traction and intact ellipsoid area, and ‘degenerative lamellar holes’ characterized by intraretinal cavitations, non-tractional epiretinal proliferation, and a retinal bump

• Nowadays Despite developments in the literature and the number of articles proposing the best surgical management of LMHs, a unanimous strategy has not been reached.

• Currently, the procedure performed in a surgical approach consists of pars plana vitrectomy with the induction of the PVD and the removal of posterior hyaloid and vitreal cortex. After removing the epiretinal component, it is usually necessary to peel the inner limiting membrane. Subsequently, a temporary intravitreal tamponade (air or gas) can be used.

• More recently the ‘Macular Hole Delphi Consensus Statement’ has reported strong agreement about that the first procedure should be peeling of both the ILM and LHEP. A moderate consensus was reached about the tamponade, and it emerged that most of the VR experts recommend gas tamponade (SF₆6 20%) instead of BSS.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conceptualization, A.S. and P.B.; methodology, A.S.; validation, S.M.P., C.C. and G.G.; investigation A.B., S.M.P. and R.C.; data curation, L.G. writing – original draft preparation, A.S. and P.B.; writing – review and editing, A.S.; visualization, T.C.; supervision, T.C. and S.R. All authors have read and agreed to the published version of the manuscript.

Acknowledgments

The manuscript was edited by the expert staff of American Manuscript Editors, all of whom are native English speakers. Moreover, the document was edited for proper English language, grammar, punctuation, and spelling.

Additional information

Funding

This paper was not funded.