Session Title: Vitreoretinal Surgery II
Session Date/Time: Friday 18/09/2015 | 08:00-10:00
Paper Time: 09:12
First Author: : P.Sin HONG KONG
Co Author(s): : T. Liu A. Young
PURPOSE:Myopia is a common refractive error worldwide, and is more prevalent in Asia. Myopic maculopathy, could lead to legal blindness. Treatment standards and studies on choroidal neovascularization (CNV) related myopic maculopathy and full thickness macula hole are well established. However, studies about natural course of lamellar holes in myopic patients have not been largely available. Outcomes of surgical treatment also varied. The purpose of this prospective study was to determine the natural course of myopic maculopathy with lamellar hole, in terms of visual and anatomical changes guided by optical coherence tomography (OCT).
The Prince of Wales Hospital in Hong Kong, approved the protocol for this study and informed consent was obtained from all patients. Patients were recruited into prospective observational study during period July 2013 to Aug 2014, and were followed up with ocular examination and OCT investigation.
Patients with myopia (spherical equivalents of an eye more than -6.00D, or an axial length greater than 26.5mm), clinically suspected or diagnosed with lamellar hole under biomicroscopy will be recruited for macular OCT scans at the Prince of Wales Hospital. Those with lamellar hole confirmed with OCT will be recruited. Baseline best-corrected visual acuity (BCVA), diameter of the lamellar hole opening, foveal thickness, presence of any patchy choroioretinal atrophy, epiretinal membrane, posterior vitreous detachment and vitreotraction are recorded. Patients were followed up every 3 months and with OCT follow-ups.
A total of 18 patients (19 eyes) with lamellar hole were recruited. The mean follow up period was 10.1 +/- 3.8 months (range 6 to 19 months). 12 patients (67%) were female. The mean age of patient at entry was 60.6 +/-9.2 years. 9 patients were phakic. The mean refractive error was -7.8 +/-3.4 D (range: -4D to -14D) for phakic patients. The mean axial length for all patients was 28.0 +/-1.61mm (range 26.57 to 31.04mm). Epiretinal membrane was observed in 37% of eyes. A Weiss ring was observed in 11% of eyes. Patchy chorioretinal atrophy was present in 56% of eyes. 47% of eyes had macula retinoschisis showed in initial OCT. The baseline BCVA was 0.39 LogMar (mean Sellen 20/50, range 20/30 to 20/200). There was no significant change in the VA (difference -0.003 LogMar; paired t-test; P=0.953) at last follow up. The OCT retinal morphology (foveal thickness, lamellar hole inner diameter remained unchanged, (161 vs 159um) and (686um vs 631um) respectively. Except in one patient, who had coexisting foveoschisis, developed foveal detachment at month 9 and underwent vitrectomy + ILM peeling with gas tamponade.
A lamellar hole in high myopic eye is relatively stable. Most patient’s visual acuity and morphology maintain unchanged, in mean follow up period of 10 months and up to 19 months.