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Results of lamellar macular hole-associated epiretinal proliferation embedding technique for the treatment of degenerative lamellar macular hole

Graefe's Archive for Clinical and Experimental Ophthalmology volume 257, pages 2147–2154 (2019)Cite this article

Abstract

Purpose

To investigate the outcomes of embedding lamellar hole-associated epiretinal proliferation (LHEP) into retinal cleavage for the surgical treatment of degenerative lamellar macular hole (LMH).

Methods

We retrospectively reviewed the medical records of 34 consecutive eyes of degenerative LMH patients who underwent vitrectomy with LHEP embedding and who were followed up for at least 12 months. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), and macular structure preoperatively and at the final follow-up were compared.

Results

The mean (±SD) follow-up period was 30.0 ± 17.7 months. Twelve patients (35.3%) were men, and the mean age was 69.6 ± 10.1 years. Twenty-three eyes (67.6%) underwent simultaneous cataract surgery. BCVA was significantly improved at the final visit, from 0.31 ± 0.25 logarithm of the minimum angle of resolution units to 0.10 ± 0.25 (P < 0.01). This improvement in mean BCVA at the final postoperative visit occurred regardless of whether the eyes underwent simultaneous cataract surgery, from 0.30 ± 0.26 preoperatively to 0.04 ± 0.16 (P < 0.01) in the “with cataract surgery” group and from 0.32 ± 0.26 preoperatively to 0.21 ± 0.35 (P < 0.05) in the “without cataract surgery” group. CRT was also significantly improved at the final visit, from 123.2 ± 42.6 μm preoperatively to 191.2 ± 42.6 μm (P < 0.01). External limiting membrane and ellipsoid zone defects were detected in 17 (50.0%) and 15 (44.1%) eyes, respectively, but these were resolved in 10 (58.8%) and 7 (46.7%) eyes, respectively, at the final visit. No intraoperative or postoperative complications were observed.

Conclusions

Embedding LHEP may be an effective and safe procedure to treat degenerative LMH.

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Author information

Affiliations

  1. Department of Ophthalmology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho Kita-ku,, Okayama City, Okayama, 700-8558, Japan

    Kosuke Takahashi, Yuki Morizane, Shuhei Kimura, Yusuke Shiode, Shinichiro Doi & Fumio Shiraga

  2. Kurashiki Medical Center, Okayama, Japan

    Toshio Okanouchi

  3. Takasu Eye Clinic, Okayama, Japan

    Ippei Takasu

  4. Inoue Eye Clinic, Okayama, Japan

    Yasushi Inoue

Authors
  1. Kosuke Takahashi
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  2. Yuki Morizane
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  3. Shuhei Kimura
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  4. Yusuke Shiode
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  6. Toshio Okanouchi
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  7. Ippei Takasu
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  9. Fumio Shiraga
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Correspondence to Yuki Morizane.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the ethics committees of Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kurashiki Medical Center, Takasu Eye Clinic, and Inoue Eye Clinic and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Online Resource 1

.mp4 After core vitrectomy, lamellar hole-associated epiretinal proliferation (LHEP) was centripetally peeled from the retina using microforceps but was left attached to the edge of the LMH. Next, brilliant blue-assisted ILM peeling was performed around the LMH in a circumferential manner. The LHEP was gently massaged centripetally over the LMH so that the LHEP was embedded into the retinal cleavage of the LMH. If the area of the LHEP was larger than that of the LMH, the LHEP was trimmed to fit the size of the retinal cleavage. Fluid-air exchange was performed at the end of surgery (MOV 316729 kb)

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Takahashi, K., Morizane, Y., Kimura, S. et al. Results of lamellar macular hole-associated epiretinal proliferation embedding technique for the treatment of degenerative lamellar macular hole. Graefes Arch Clin Exp Ophthalmol 257, 2147–2154 (2019). https://doi.org/10.1007/s00417-019-04425-9

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  • DOI: https://doi.org/10.1007/s00417-019-04425-9

Keywords

  • Degenerative lamellar macular hole
  • Lamellar macular hole-associated epiretinal proliferation
  • Surgical technique
  • Visual acuity