J Korean Ophthalmol Soc.  2009 Sep;50(9):1427-1431. 10.3341/jkos.2009.50.9.1427.

Four Cases of Pars Plana Vitrectomy for Treatment of Symptomatic Lamellar Macular Holes

• Cho WB
• Shin HJ
• Moon JW
• Kim HC

• KMID: 2212630
• DOI: http://doi.org/10.3341/jkos.2009.50.9.1427

Abstract

PURPOSE
To report the results of pars plana vitrectomy for the treatment of symptomatic lamellar macular holes. CASE SUMMARY: Pars plana vitrectomy with epiretinal membrane (ERM) and internal limiting membrane (ILM) stripping was performed for the treatment of lamellar holes in four patients who complained of vision loss or metamorphopsia. In three out of four patients, fluid-gas exchange with 14% C3F8 was performed and patients were instructed to maintain aprone position for 7 days after surgery. Postoperatively, the improvement of visual acuity, foveal contour, and disappearance of metamorphopsia were achieved in three patients. However, full-thickness macular hole (FTMH) developed in one patient after vitrectomy. Repeated fluid-gas exchange was performed and the patient was instructed to maintain a prone position, however, the FTMH did not close. CONCLUSIONS: In patients with visual loss or metamorphopsia, vitrectomy with ERM and ILM stripping appears to be a beneficial treatment. FTMH developed after surgery in one patient, therefore further study is needed to elucidate the prognostic factors for the development of FTMH.

Keyword

Lamellar Macular Hole; Pars Plana Vitrectomy

MeSH Terms

Epiretinal Membrane
Humans
Membranes
Prone Position
Retinal Perforations
Vision Disorders
Vision, Ocular
Visual Acuity
Vitrectomy

Figure

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  Figure 1. Case 1. (A) Optical coherence tomography findings before surgery show lamellar macular hole with detached posterior hyaloid adherent to operculum, and intact foveal photoreceptors (asterisk). Thin, high reflective layer at the level of the inner retinal surface which corresponds to the epiretinal membrane is seen. Preoperative BCVA is 0.4. (B) Optical coherence tomography findings at 4 weeks after surgery show the disappearance of vitreomacular traction and intraretinal split, and almost normalized foveal configuration as well.

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  Figure 2. Case 2. (A) Optical coherence tomography findings before surgery show lamellar macular hole with thickened epiretinal membrane, intraretinal split, intact photoreceptors. Preoperative BCVA is 0.5. (B) OCT findings at 4 weeks after surgery show much improved foveal configuration despite foveal thickening. Best corrected visual acuity improved to 0.8 and her symptom of metamorphopsia disappeared.

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  Figure 3. Case 3. (A) Optical coherence tomography findings before surgery show typical lamellar macular hole with irregular foveal contour, break in theinner fovea, intraretinal split and intact photoreceptors (asterisk). Preoperative visual acuity is 0.4. (B) Optical coherence tomography findings at 1 month after surgery show the disappearance of intraretinal split, and almost normalized foveal contour. (C) Spectral domain Optical coherence tomography findings at 3 months after surgery show normal foveal configuration. Best corrected visual acuity improved to 0.7.

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  Figure 4. Case 4. (A) Optical coherence tomography findings show lamellar macular hole with extensive intraretinal split and intact photoreceptors (asterisk). Preoperative VA is 0.1. (B) OCT findings at 1 month after surgery show full-thickness macular hole with elevated margin. Fluid-gas exchange is performed. (C) Optical coherence tomography findings at 3 months after surgery show persistent full-thickness macular hole with reattched margin. BCVA is counting finger.

Reference

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