Four Cases of Pars Plana Vitrectomy for Treatment of Symptomatic Lamellar Macular Holes

Won Bin Cho; Hyun Jin Shin; Jun Woong Moon; Hyung Chan Kim

doi:10.3341/jkos.2009.50.9.1427

Journal List > J Korean Ophthalmol Soc > v.50(9) > 1008375

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Cho, Shin, Moon, and Kim: Four Cases of Pars Plana Vitrectomy for Treatment of Symptomatic Lamellar Macular Holes

Original Article

J Korean Ophthalmol Soc 2009;50(9):1427-1431.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.9.1427

Four Cases of Pars Plana Vitrectomy for Treatment of Symptomatic Lamellar Macular Holes

Won Bin Cho, MD, Hyun Jin Shin, MD, Jun Woong Moon, MD, Hyung Chan Kim, MD, PhD

Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea

Address reprint requests to Hyung Chan Kim, MD, PhD Department of Opthalmology, Konkuk University Medical Center, Konkuk University School of Medicine #4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea Tel: 82-2-2030-5270, Fax: 82-2-2030-5273, E-mail: eyekim@kuh.ac.kr

Received 20 November 2008 Accepted 26 May 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the results of pars plana vitrectomy for the treatment of symptomatic lamellar macular holes.

Case summary

Pars plana vitrectomy with epiretinal membrane (ERM) and internal limiting membrane (ILM) stripping was performed for the treatment of lamellar holes in four patients who complained of vision loss or metamorphopsia. In three out of four patients, fluid-gas exchange with 14% C₃ F₈ was performed and patients were instructed to maintain aprone position for 7 days after surgery. Postoperatively, the improvement of visual acuity, foveal contour, and disappearance of metamorphopsia were achieved in three patients. However, full-thickness macular hole (FTMH) developed in one patient after vitrectomy. Repeated fluid-gas exchange was performed and the patient was instructed to maintain a prone position, however, the FTMH did not close.

Conclusions

In patients with visual loss or metamorphopsia, vitrectomy with ERM and ILM stripping appears to be a beneficial treatment. FTMH developed after surgery in one patient, therefore further study is needed to elucidate the prognostic factors for the development of FTMH.

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Keywords: Lamellar Macular Hole, Pars Plana Vitrectomy

References

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Figure 1.

Case 1. (A) Optical coherence tomography findings before surgery show lamellar macular hole with detached posterior hyaloid adherent to operculum, and intact foveal photoreceptors (asterisk). Thin, high reflective layer at the level of the inner retinal surface which corresponds to the epiretinal membrane is seen. Preoperative BCVA is 0.4. (B) Optical coherence tomography findings at 4 weeks after surgery show the disappearance of vitreomacular traction and intraretinal split, and almost normalized foveal configuration as well.

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Figure 2.

Case 2. (A) Optical coherence tomography findings before surgery show lamellar macular hole with thickened epiretinal membrane, intraretinal split, intact photoreceptors. Preoperative BCVA is 0.5. (B) OCT findings at 4 weeks after surgery show much improved foveal configuration despite foveal thickening. Best corrected visual acuity improved to 0.8 and her symptom of metamorphopsia disappeared.

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Figure 3.

Case 3. (A) Optical coherence tomography findings before surgery show typical lamellar macular hole with irregular foveal contour, break in theinner fovea, intraretinal split and intact photoreceptors (asterisk). Preoperative visual acuity is 0.4. (B) Optical coherence tomography findings at 1 month after surgery show the disappearance of intraretinal split, and almost normalized foveal contour. (C) Spectral domain Optical coherence tomography findings at 3 months after surgery show normal foveal configuration. Best corrected visual acuity improved to 0.7.

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Figure 4.

Case 4. (A) Optical coherence tomography findings show lamellar macular hole with extensive intraretinal split and intact photoreceptors (asterisk). Preoperative VA is 0.1. (B) OCT findings at 1 month after surgery show full-thickness macular hole with elevated margin. Fluid-gas exchange is performed. (C) Optical coherence tomography findings at 3 months after surgery show persistent full-thickness macular hole with reattched margin. BCVA is counting finger.

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Table 1.

Characteristics of patients

	Case 1	Case 2	Case 3	Case 4
Preop. BCVA^∗	0.4	0.5	0.4	0.1
ERM^†	+	+	+	-
PVD^‡	- (VMT^∏)	-	+	-
ILM^§ peeling	+	+	+	+
Gas tamponade	+	+	-	+
Postop. BCVA	0.5	0.8	0.7	FC/50 cm
OCT	Normalized	Normalized	Normalized	FTMH^#

^∗ BCVA=best corrected visual acuity;

^† ERM=epiretinal membrane;

^‡ PVD=posterior vitreous detachment;

^§ ILM=internal limiting membrane;

^∏ VMT=vitreomacular traction;

^# FTMH=full-thickness macular hole.

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