Session Title: Vitreoretinal Surgery I
Session Date/Time: Thursday 17/09/2015 | 08:30-10:30
Paper Time: 09:34
First Author: : S.MendezMartinez SPAIN
Co Author(s): : M. Bande Rodriguez A. Pineiro-Ces F. RuizOliva C. Capeans Tome M. BlancoTeijeiro
PURPOSE:To study the characteristics and evolution of the lamellar macular holes (LMH) by their epiretinal membrane (ERM) associated and to make comparisons between the parameters of operated and untreated eyes.
Retinal Surgery and Ocular Oncology Unit. Department of Ophthalmology. Complexo Hospitalario Universitario de Santiago de Compostela. Spain.
We consecutively reviewed the charts of 40 patients (42 eyes) with a LMH diagnosis between 2010 and 2014. All patients were studied by spectral domain optical coherence tomography (SD-OCT). For clinical analysis, we included 42 eyes with a minimum follow-up of 6 months and mean follow-up of 20 months. LMH–associated to “dense epiretinal membrane” (LMH-D) was defined on SD-OCT imaging as an epiretinal material proliferation with medium homogenous reflectivity. LMH-associated to “tractional epiretinal membrane” (LMH-T) was defined on SD-OCT imaging as an epiretinal material of hyper-reflectivity and tensile properties over the inner retina. The measures of the anatomical parameters, the integrity of ellipsoid layer and external limiting membrane (ELM) and the best corrected visual acuity (BCVA) were analyzed and compared by the sort of ERM. These outcomes were also compared between operated and untreated eyes.
All LMH were associated with ERM; 8 eyes (19.1%) were LMH-D, 31 (73.8%) had LMH-T and a mixed membrane was detected in 3 eyes (7.1%). Only the base of LMH–T increased significantly in comparison with the parameters of LMH-D, which remained stable (p=0.01). Among all eyes with LMH-T, only 3 (9.7%) showed defects on ellipsoids and none of them had defects on ELM; in contrast, 27.3% of LMH-D showed defects on both layers. All LMH-D showed a gliotic tissue in their foveal defect, which was significantly associated with a lack of integrity in both, ellipsoid and ELM (p=0.01). Patients with ellipsoids integrity had a significantly better BCVA (0.214±0.101 logMAR) than those with defects (0.353±0.399 logMAR) (p=0.02). Likewise, LMH-D patients had a worse initial BCVA (0.491±0.079 logMAR) than those with LMH-T (0.345±0.040 logMAR) (p=0.04). Over the mean retrospective follow-up, significant differences in the residual foveal thickness were observed after surgery (p=0.01), with lower outcomes for the vitrectomy group (95% CI: 31-162 mm). In the LMH-T group, the final BCVA was significantly poorer for the surgery group (0.491±0.105 logMAR) than in the observation one (0.255±0.035 logMAR) (p=0.01).
SD-OCT imaging showed that patients with LMH-D differ from conventionally tractional ERMs in their appearance and the induced changes of the underlying retina. Eyes with LMH-D were associated with a poorer visual acuity, more stable LMH diameters, a gliotic tissue within the foveal defect and a higher incidence of ellipsoid disruption compared with eyes with LMH-T, suggesting a process involving more severe retinal tissue loss and injury. Both LMH with and without dense proliferation seemed to have stable configurations over time. Vitrectomy for LMH was associated with a worse BCVA and a thinner retinal thickness, although further studies with more patients should be performed to ensure these results.