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Lamellar macular hole in highly myopic eyes and insights into its development, evolution, and treatment: a mini-review

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Abstract

Lamellar macular holes (LMHs) are a manifestation of myopic tractional maculopathy (MTM). Owing to the complex and multidirectional traction force in the elongated eyeball, the clinical features, development, evolution, and treatment algorithms of LMH in highly myopic eyes may differ from those of idiopathic LMH or MTM in general. This review aimed to specifically explore the LMHs in highly myopic eyes. Several developmental processes of LMH and their association with macular retinoschisis have been demonstrated, with the tractional component identified in all processes. Epiretinal proliferation was more prevalent and more extensive in LMHs in highly myopic eyes than in idiopathic LMHs. LMHs in highly myopic eyes may remain stable or progress to foveal detachment and full-thickness macular hole with or without retinal detachment. The predictive factors associated with disease progression were summarized to facilitate monitoring and guide surgical intervention. The treatment of LMHs in highly myopic eyes was based on an algorithm for treating myopic tractional maculopathy, including gas tamponade, pars plana vitrectomy, macular buckling, and a combination of vitrectomy and macular buckling. New internal limiting membrane (ILM) manipulation techniques such as fovea-sparing ILM peeling or fovea-sparing ILM peeling combined with ILM flap insertion could reduce the risk of developing iatrogenic full-thickness macular holes postoperatively. Further research should focus on the treatment of LMH in highly myopic eyes.

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  1. Tso-Ting Lai and Yun Hsia contributed equally as the first authors.

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  1. Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei City, Taiwan

    Tso-Ting Lai, Yun Hsia & Chung-May Yang

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  2. Yun Hsia
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All the authors contributed to the conception and design of this study. The material was prepared by Tso-Ting Lai and Yun Hsia. The initial draft of the manuscript was written by Tso-Ting Lai and Yun Hsia, and all the authors commented on the previous versions of the manuscript. All the authors have read and approved the final version of the manuscript.

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Correspondence to Chung-May Yang.

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Lai, TT., Hsia, Y. & Yang, CM. Lamellar macular hole in highly myopic eyes and insights into its development, evolution, and treatment: a mini-review. Graefes Arch Clin Exp Ophthalmol (2024). https://doi.org/10.1007/s00417-024-06419-8

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