Review Article

The Management of Lamellar Macular Holes: A Review

Table 2

Interventional studies.

AuthorNo. of eyes (type of tamponade)Mean follow-up in months (range)Lens statusMean visual acuity evolution (logMAR)Percentage of eyes that gained /lost VAAnatomical evolutionComments

Garretson et al. [39]27 (22 gas or air)9 (2–33)Mean improvement 3.2 lines93% gained VA
7% lost VA
4.7% of eyes developed FTMH
92% improved OCT

Androudi et al. [36]
Prospective study
20 (C3F8)(12–46)60% were pseudophakic
40% phaco in the first year
Mean improvement 2.6 lines85% gained VA70% almost normal foveal contour
25% improved
5% no change

Michalewska et al. [37]26 (No tamponade)1219.2% phaco in the first yearInitial VA 0.2 Snellen
Final VA 0.51
92% gained 2 lines
3.8% lost 2 lines
50% normal foveal contour
27% irregular foveal contour
IS/OS defects: 30% initial
7.6% final
Eyes with fotoreceptor damage ⟶ final VA <0.2 Snellen

Figueroa et al. [43]12 (C3F8)16.1No phacoInitial VA 0.34
Final VA 0.17
75% gained 2 lines
25% stable VA (2 needed reoperation for FTMH)
0% lost VA
16.6% of eyes developed FTMH

Casparis and Bovey [49]45 (43 air or gas)38% phacoInitial VA 0.4
Final VA 0.13
58% gained 2 lines
0% lost VA

Parolini et al. [16]19 (air)
(i) 13 dense ERM
(ii) 6 tractional ERM
1236% pseudophakic
64% phaco-vit
Dense ERM:
Initial VA 0.4,
Final VA 0.2
Tractional ERM:
Initial VA 0.4,
Final VA 0.2
73% gained VA
0% lost VA
15.7% of eyes developed FTMH

Lee et al. [40]31 (SF6)39 (12–80)29% were pseudophakic
41.9% phaco-vit
19.4% phaco after vitrectomy
Initial VA 0.41
3 months 0.27, 6 months 0.24, 12 months 0.22, 39 months 0.23
Mean gain 0.17
58.1% gained 2 lines
6, 5% lost VA (CMO, recurrence of LMH)
62.5% normal foveal contour
25% improved foveal appearance

Lee et al. [50]3016.6% were pseudophakic
60% phaco-vit
23.3% remained phakic
Cataract surgery did not correlate with final VA
Initial VA 0.51
Final VA 0.4
63% gained VA
20% stable VA
17% lost VA
In the group with intact IS/OS, VA increased from 20/50 to 20/32
VA did not increase:
(i) In the group with IS/OS disruption
(ii) If initial VA <0.2 Snellen
(iii) If initial foveal thickness <100 μm

Celik et al. [25]19 (SF6 or C2F6)17.542% phacoInitial VA 0.54
Final VA 0.33
10.5% of eyes developed FTMH
(i) 1 reoperated successfully
5 eyes had IS/OS defects⟶
2 were partially restored
52% normalised foveal contour
31% improvement
10% no change
Eyes with IS/OS defects did not improve VA even if defects were closed

Sun et al. [41]30
(22 with C3F8 and 8 no tamponade)
16.946.6% were pseudophakic
30% phaco after vitrectomy
23.3% remained phakic
With C3F8:
Initial VA 0.77
Final VA 0.44
Without C3F8:
Initial VA 0.89
Final VA 0.52
Mean gain 3.4 lines
83% gained VA
63% gained 3 lines
0% lost VA
IS/OS defects:
63.3% preoperatively
43% postoperatively
73.3% restored foveal contour
16.6% improved contour
10% persistent defect
3.3% of eyes have developed FTMH
Final BCVA is associated with intact IS/OS line
No significant difference in the initial and final VA between eyes with/without gas tamponade

Sato et al. [38]41
(23 air and 18 no tamponade)
685.3% phacoWith air:
Initial VA 0.26
Final VA 0.12
No tamponade: Initial VA 0.35
Final VA 0.14
2 lines VA gain:
With air 30.4%
Without air 61.1%
IS/OS disruption in 5 eyes⟶restored postoperatively
ELM disruption in 2 eyes⟶restored postoperatively
No significant difference in the initial and final VA between eyes with/without air tamponade

Lai et al. [42]43 (C3F8)
44% LHEP
56% no LHEP
Minimum 12Initial VA 0.78
Final VA 0.44
Initial VA 0.71
Final VA 0.42
IS/OS defects
Initial 68.4
Final 36.8
Initial 37.5
Final 33.3
VA increased similarly in both groups (with/without LHEP)

Ko et al. [51]58/73 LHEP
15/73 no LHEP
21.5Phaco 75.9%
Phaco 53.3%
Initial VA 0.3
Final VA 0.1
Initial VA 0.38
Final VA 0.33
No patient with IS/OS disruption had restored IS/OS line
4.5% developed IS/OS disruption postoperatively
Final VA significantly better in eyes without LHEP

Coassin et al. [31]106 (air/SF6/C3F8)36 (1–116)37% phaco-vit
28% phaco after vit
Initial VA 0.45
Final VA 0.31
53% gained 2 lines
11% VA stable
20% lost VA
2.8% of eyes have developed FTMH
1 retinal detachment
Restored foveal contour 66%
VA improved in tractional and mixed, but not in degenerative LMH
VA did not increase in the eyes that were previously pseudophakic (18 eyes) or those that remained phakic at the end of follow-up (19 eyes)

Purtskhvanidze et al. [27]1185 (60–140)28% were pseudophakic
72% phaco-vit (although they did not have cataract)
Initial VA 0.4
Immediately before vitrectomy 0.5
Final VA 0.3

Figueroa et al. [52]77 tractional LMH (with premacular membranes)
26 degenerative LMH (with LHEP)
30.8 (6–96)12.6% phaco-vit
(83.5% pseudophakic at the end)
Initial VA 0.39
Final VA 0.18
Initial VA 0.56
Final VA 0.39
14.3% initial outer retina disruption
7.7% final outer retina disruption
50% initial outer retina disruption
42.3% final outer retina disruption
1.9% of eyes have developed FTMH
1 macula-on retinal detachment
The type of tamponade did not influence anatomical success
VA improvement was greater in tractional LMH

Guber et al. [53]36363.9% phaco-vitInitial VA 0.3
Final VA 0.2
72% gained VA
19.5% stable VA
11.5% lost 1 line
92% improved foveal contour
0 IS/OS defects
1 macula-on retinal detachment

Morescalchi et al. [44]
prospective
24 degenerative LMH (with LHEP)6Initial VA 0.44
Final VA 0.17
79% restoration of foveal appearanceFovea sparing technique (ILM left intact 2 optic disc diameters around fovea)

Takahashi et al. [46]34 degenerative LMH (of which 10 had high myopia)30 (12–82)67.6% phaco-vitInitial VA 0.31
Final VA 0.1
47% gained 2 lines
53% stable VA
0% lost 2 lines
59% recovery of ERM
47% recovery of IS/OS line
Embedding of LHEP into the retinal cleavage of the LMH

Statistically significant difference; no significant difference.