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

Figures & data

Figure 1 Structural features of the lamellar macular hole types (tractional vs degenerative) studied by optical coherence tomography. Representative images of the tractional type are shown: (A) the callipers show the following measurements - Purple: base size of the hole; Red: top size of the hole. The schisis of the retinal layers is visible from the multiple narrow hyperreflective tissue bridges crossing the intraretinal splitting; (B) A tractional LMH with posterior vitreous detachment (yellow triangle), intraretinal cavities, sharp splitting edges, and EZ continuity are shown in the “moustache”-like morphology; (C) The traction of the ERM on the top of retina pulls the edges antero-lateral, thus splitting the retinal layers into a lamellar macular hole. The purple calliper measures the top size of the hole, while the red calliper measures the MFT. Representative images of the degenerative type are shown: (D) A round-edged cavitation, with a foveal bump and epiretinal proliferation is detected in the “top hat” morphology. The MFT was measured manually using a calliper (Purple), as the thinnest vertical distance from the base of the LMH down to the Bruch’s membrane. Horizontal lines - purple: Bruch’s membrane, blue: Ellipsoid Zone (EZ); green: Outer Nuclear Layer (ONL); (E) Round-edged cavitation, with a foveal bump, and EZ disruption (blue horizontal line); MFT (red); (F) the callipers show the following measurements - Purple: top size of the hole; Red: base size of the hole.

Table 1 Characteristics of the Studied Population

	LMH Type
	Degenerative	Tractional	Total
	N = 19	N = 47	N = 66
	(%)	(%)	(%)
Gender
Male	5 (26.32)	18 (38.30)	23 (34.85)
Female	14 (73.68)	29 (61.70)	43 (65.15)
Age (mean+SD)	70.47+8.70	72.32+8.48	71.79+8.52
Diabetes mellitus	1 (5.26)	9 (19.15)	10 (15.15)
Glaucoma	3 (15.79)	5 (10.64)	8 (12.12)
Phacoemulsification
Preoperative	3 (15.79)	12 (25.53)	15 (22.73)
Phaco-vitrectomy	4 (21.05)	27 (57.45)	31 (46.97)
Postoperative	11 (57.89)	4 (8.51)	15 (22.73)
Type of tamponade
BSS	15 (78.95)^a	8 (17.02)^b	23 (34.85)
Air	2 (10.53)^a	24 (51.06)^b	26 (39.39)
Gas	2 (10.53)^a	15 (31.91)^a	17 (25.76)

Notes: Each subscript letter ^{(a, b)}Denotes a subset of LMH type categories whose column proportions do ^{(a, b)}Or do not differ ^{(a, a)}Significantly from each other at the 0.05 level. P < 0.05; After Bonferroni correction: P < 0.017 (3 pairwise comparison shown in bold when significant).

Abbreviations: N, number; SD, standard deviation; LMH, lamellar macular hole; BSS, balanced salt solution.

Table 2 Preoperative OCT Characteristics of the Studied Population

	LMH Type
	Degenerative	Tractional
	N (%)	N (%)
CFT (mean+SD)	209.8+60.4	397.9+117.7
MFT (mean+SD)	215.5+66.3	211.3+79.2
EZ continuity
No	2 (105)	8 (17)
Yes	17 (89.5)	39 (83)
ERM presence
No	3 (15.8)	0 (0)
Yes	16 (84.2)	47 (100)
LHEP presence
No	14 (73.7)	33 (50)
Yes	5 (26.3)	14 (21.2)
Base size	703	483
(Median, IQR),¨	(530–910)	(230–1019)
Range	155–1452	75–2541
Top size	472	374
(Median, IQR),¨	(339–611)	(283–517)
Range	172–899	137–1581

Note: P < 0.05. Difference between degenerative and tractional (in bold).

Abbreviations: N, number; SD, standard deviation; CFT, central foveal thickness; MFT, minimal foveal thickness; EZ, ellipsoid zone; ERM, epiretinal membrane; LHEP, LMH-associated epiretinal proliferation; IQR, interquartile range.

Table 3 Postoperative Anatomical OCT Parameters

	LMH Type		Total N = 54 (%)
	Degenerative	Tractional
	N = 18 (%)	N = 36 (%)
Foveal profile
Symmetrical	10 (55.6)	19 (52.8)	29 (53.7)
Asymmetrical	8 (44.4)	17 (47.2)	25 (45.5)
Intraretinal cysts	1 (5.6)	13 (36.1)	14 (25.9)
FTMH development	0	0	0

Abbreviations: N, number; FTMH, full-thickness macular hole.

Figure 2 Relationship between pre- and post- operative BCVA (logMAR) in the studied groups. (A) LMH type; (B) vitrectomy; (C) tamponade. *P<0.05; **P<0.01.

Abbreviations: BSS, balanced salt solution; BCVA, best corrected visual acuity; MAR, minimum angle of resolution.

Table 4 Relationship Between Pre- and Postoperative BCVA (logMAR) in the Studied Groups

	Pre-Operative	Post-Operative
	(Median, IQR, Range)	(Median, IQR, Range)
	BCVA (logMAR)
Tamponade
BSS	0.4 (0.3–0.6)	0.15 (0.05–0.4)
	0.05–1.2	0–0.6
Air	0.3 (0.2–0.5)	0.26 (0.2–0.3)
	0–1.7	0.05–0.1
Gas	0.3 (0.2–0.4)	0.2 (0.1–0.3)
	0.1–1.7	0.1–0.5
Phaco-vitrectomy
No	0.3 (0.2–0.6)	0.2 (0.1–0.3)
	0–1.2	0.1–0.5
Yes	0.4 (0.2–0.5)	0.2 (0.15–0.3)
	0.05–1.7	0–1
LMH type
Degenerative	0.5 (0.3–0.6)	0.2 (0.15–0.5)
	0.1–1.2	0.1–1.2
Tractional	0.3 (0.2–0.5)	0.2 (0.1–0.3)
	0–1.7	0–1

Note: P < 0.05. Difference between pre- and post-operative measurements (in bold).

Abbreviations: BCVA, best corrected visual acuity; MAR, minimum angle of resolution; IQR, interquartile range; LHEP, LMH-associated epiretinal proliferation; EZ, ellipsoid zone.