Surgical treatment of lamellar macular hole

Purpose. Vitrectomy and peeling in patients with lamellar macular hole was evaluated with regard to anatomical and functional outcome. Patients and methods. In a retrospective study, 10 patients with lamellar macular hole underwent vitrectomy, membrane-peeling (epiretinal membrane [ERM] and internal limiting membrane [ILM]) and gas (n=9) or silicone oil (n=1) endotamponade. In most patients (n=9), cataract surgery was also performed. Pre- and postoperative ocular coherence tomography (OCT) findings, visual acuity (ETDRS), and Birkhauser near visual acuity were evaluated. Results. Mean follow-up was 15 +/- 11 months after surgery with a minimum follow-up of 6 months. Best corrected visual acuity (BCVA) improved in all patients; the average BCVA gain was 3 +/- 2 lines. Preoperative mean BCVA was 0.35 (0.45 +/- 0.23logMAR), and postoperative BCVA was 0.64 (0.19 +/- 0.21logMAR). Eight of ten patients had a postoperative BCVA >= 20/40, and six patients had a postoperative BCVA >= 20/25. Mean near visual acuity was 0.5 +/- 0.26 (range 0.2-0.9). Postoperative OCT revealed a closed lamellar macular hole in six patients, with restored foveal contour in three of them. The other four patients showed a persistent inner retinal defect with an intact photoreceptor layer. Conclusion. Surgical treatment including vitrectomy, ERM-ILM-peeling and endotamponade appears to benefit patients with lamellar macular hole. All patients improved functionally. Surgical treatment can close the lamellar macular hole and restore foveal architecture.