OCT-Defined Foveal Restoration Is Associated with Visual Recovery after Vitrectomy for Lamellar Macular Hole: A Multicenter Study: LMH Report No. 1.

PURPOSE: Anatomic restoration after vitrectomy for lamellar macular hole (LMH) is not always achieved. However, the impact of unresolved LMH on visual outcomes remains unclear. We evaluated postoperative outcomes in eyes with unresolved LMH and postoperative full-thickness macular hole (FTMH) to reassess the meaning of anatomic success after LMH surgery.

DESIGN

Multicenter, retrospective cohort study.

SUBJECTS: One hundred sixty-six consecutive eyes of 166 patients who underwent vitrectomy for LMH.

METHODS

Anatomic success was defined as restoration of foveal configuration, whereby the postoperative OCT findings no longer met the diagnostic criteria for LMH. Postoperative anatomic outcomes were classified as anatomic success, unresolved LMH (including both persistent or recurrent LMH), or postoperative FTMH.

MAIN OUTCOME MEASURES: Incidence and risk factors of unresolved LMH and postoperative FTMH, and best-corrected visual acuity (BCVA).

RESULTS

Anatomic success was achieved in 141 eyes (84.9%), whereas 14 eyes (8.4%) had unresolved LMH and 11 eyes (6.6%) progressed to FTMH during follow-up (mean, 17.8 months). At 12 months, BCVA was significantly worse in eyes with unresolved LMH than in those with anatomic success (0.24 ± 0.24 vs. 0.09 ± 0.19 logarithm of the minimum angle of resolution [LogMAR]; P = 0.041). Internal limiting membrane (ILM) peeling was significantly associated with a reduced risk of unresolved LMH (odds ratio [OR], 0.011; 95% confidence interval [CI], 0.002-0.062; P < 0.001). Postoperative FTMH was significantly associated with epiretinal proliferation (P = 0.018), thinner preoperative central foveal thickness (P = 0.017), and no ILM peeling (P = 0.001). Multivariable analysis confirmed that ILM peeling was an independent factor preventing postoperative FTMH (OR, 0.080; 95% CI, 0.010-0.620; P = 0.001). Postoperative FTMH achieved closure in 9 eyes (82%) with additional treatment or observation, whereas the final BCVA was significantly worse in eyes that developed FTMH than in those with anatomic success (0.50 ± 0.32 vs. 0.12 ± 0.20 LogMAR; P < 0.001).

CONCLUSIONS

Although most eyes achieved anatomic success after vitrectomy for LMH, approximately 15% developed unresolved LMH or postoperative FTMH, both of which were associated with the absence of ILM peeling. Because anatomic failure was associated with poorer visual outcomes, foveal restoration on OCT may represent a more clinically meaningful anatomic endpoint after LMH surgery.

FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.