Long-term optical coherence tomography changes and visual outcomes after vitrectomy for epiretinal proliferation: lamellar holes and full-thickness macular holes

TL;DR

This study shows that vitrectomy and ILM peeling improve vision in patients with macular holes caused by epiretinal proliferation, especially those with worse initial vision.

Contribution

The study provides evidence that surgical treatment improves visual and anatomic outcomes for DLMH and FTMH secondary to ERP.

Findings

FTMH cases showed statistically significant visual improvement after surgery.

Baseline visual acuity strongly correlates with postoperative visual outcomes.

Surgical intervention benefits patients with worse preoperative vision the most.

Abstract

Epiretinal proliferation (ERP) is an extension of preretinal tissue, creating a thin, semi-translucent layer of fibrous tissue on the retina. ERP has been recently associated with degenerative lamellar macular holes (DLMH) and full-thickness macular holes (FTMH). The proposed surgery for patients has been vitrectomy and ERM peeling, but there is no consensus on whether DLMH is a stable condition or should be resolved with surgical treatment. The purpose was to investigate optical coherence tomography (OCT) changes and visual outcomes of degenerative LMH and FTMH secondary to ERP after pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling.

This retrospective case series evaluated 14 eyes with DLMH and eight eyes with FTMH. All 22 eyes were associated with ERP and treated with PPV with ILM peeling. Best-corrected visual acuity (BCVA, in logMAR), OCT findings, including presence of foveal bump and ellipsoid zone integrity, were documented. Wilcoxon signed-rank tests were used for numerical data. Statistical significance was based on a value of p < 0.05.

Among the 14 DLMH cases, the mean Snellen equivalent VA was 20/75 at baseline; 20/59 at the 4–12-month postoperative period; and 20/56 at the final follow-up visit. For the eight FTMH cases, the mean Snellen equivalent VA was 20/94 at baseline; 20/45 at the 4–12-month postoperative period; and 20/38 at the final follow-up visit. Compared to baseline VA, FTMH cases demonstrated a statistically significant improvement in the 4–12-month postoperative VA (p < 0.05) and in the final postoperative VA (p < 0.05). Among all cases, a strong correlation was observed between baseline logMAR and change in logMAR from baseline to final follow-up (R2 = 0.671).

This study demonstrated that surgical intervention led to improved visual and anatomic outcomes in patients with DLMH and FTMH, with a correlation between baseline VA and postoperative visual outcomes. The results suggest that patients with worse preoperative VA experienced the greatest benefit in visual outcome from PPV and ILM peeling. Future studies would look at the timing of when to ideally intervene to improve anatomic and visual outcomes.

Figures