Effects of Vitrectomy on the Treatment of a Lamellar Macular Hole in Highly Myopic Patients

Hee Weon Kim; Hun Gu Choo; San Seong; Hyun Sub Oh; Yong Sung Yoo; Soon Hyun Kim; Oh Woong Kwon

doi:10.3341/jkos.2019.60.4.315

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Kim, Choo, Seong, Oh, Yoo, Kim, and Kwon: Effects of Vitrectomy on the Treatment of a Lamellar Macular Hole in Highly Myopic Patients

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(4): 315-322.

Published online: 17 April 2019

DOI: https://doi.org/10.3341/jkos.2019.60.4.315

Effects of Vitrectomy on the Treatment of a Lamellar Macular Hole in Highly Myopic Patients

Hee Weon Kim, MD, Hun Gu Choo, MD, San Seong, MD, Hyun Sub Oh, MD, PhD, Yong Sung Yoo, MD, PhD, Soon Hyun Kim, MD, PhD, Oh Woong Kwon, MD, PhD

Nune Eye Hospital, Seoul, Korea.

Address reprint requests to Oh Woong Kwon, MD, PhD. Nune Eye Hospital, #404 Seolleung-ro, Gangnam-gu, Seoul 06198, Korea. Tel: 82-2-1661-1175, Fax: 82-2-2086-7710, owkwon0301@gmail.com

Received 14 August 2018 Revised 7 November 2018 Accepted 18 March 2019

The Korean Ophthalmological Society

(open-access):

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 evaluate the efficacy of surgical treatment for a lamellar macular hole in highly myopic patients.

Methods

We retrospectively analyzed 31 eyes of 31 patients with a high myopia, who underwent 23-gauge vitrectomy and inner limiting membrane peeling after diagnosis of a lamellar macular hole. Thirty-two eyes of 32 patients with no high myopia were selected as the control group. The best-corrected visual acuity (BCVA) was checked and optical coherence tomography was used to evaluate structural changes in the lamellar macular hole before surgery, 6 months, 12 months, and 24 months after surgery.

Results

The high myopia group and the control group showed statistically significant differences between preoperative BCVA and central foveal thickness. The success of primary surgery was 96.77% in the high myopia group and 100% in the control group. At postoperative 24 months, the high myopia group showed significantly poorer BCVA, and a statistically significant difference in the central foveal thickness and the inner and outer diameters of the lamellar macular hole. In cases of foveoschisis or a very high degree of myopia of more than -8.0 diopters, there was no significant improvement in BCVA after surgery.

Conclusions

Surgical treatment of a lamellar macular hole associated with a high degree of myopia showed excellent surgical success, but was as statistically significant as surgical treatment of non-myopia eyes. Early surgical treatment can be considered for a lamellar macular hole associated with a high degree of myopia when preoperative visual acuity and macular architecture are preserved.

Keywords: Central foveal thickness, High myopia, Internal limiting membrane peeling, Lamellar macular hole

Figures and Tables

Figure 1

Preoperative parameters of spectral-domain optical coherence tomography. The red arrow indicates the inner diameter of the lamellar macular hole. The blue arrow indicates the outer diameter of the lamellar macular hole. The green arrow indicates the diameter of foveoschisis. The yellow arrow indicates the central foveal thickness.

Figure 2

The anatomical changes of the lamellar macular hole after surgery in a patient with high myopia (axial length = 30.57 mm, spherical equivalent = −16.63). (A) Preoperative fundus photograph and spectral-domain optical coherence tomography show the tigroid fundus and lamellar macular hole (LMH). (B) After 6 months postoperatively, LMH is well recovered to nearly regular foveal contour, and the measured central foveal thickness is 141 µm. (C) After 12 months postoperatively, recovered LMH is maintained, and the measured central foveal thickness is slightly decreased to 134 µm. (D) After 24 months postoperatively, the foveal contour remains stable, and the measured central foveal thickness is slightly decreased to 124 µm.

Figure 3

The anatomical changes of the lamellar macular hole after surgery in a patient with no high myopia (axial length = 23.67 mm, spherical equivalent = −0.50). (A) Preoperative fundus photograph and optical coherence tomography (OCT) show the lamellar macular hole (LMH) with epiretinal membrane (ERM). (B) After 6 months postoperatively, There is no apparent ERM both in fundus photograph and OCT, foveoschisis is resolved, and the foveal contour shows the appearance of pseudohole and the measured central foveal thickness is 204 µm. (C) After 12 months postoperatively, recovered LMH is maintained and the measured central foveal thickness is slightly decreased to 190 µm. (D) After 24 months postoperatively, the foveal contour remains stable, and the measured central foveal thickness is 214 µm.

Table 1

General characteristics of patients

Values are presented as mean ± standard deviation (range) or number (%).

D = diopter; logMAR = logarithm of the minimum angle of resolution; LMH = lamellar macular hole.

^*Paired t-test.

Table 2

The comparison of postoperative anatomical and functional changes of the lamellar macular hole with and without high myopia

Values are presented as mean ± standard deviation unless otherwise indicated.

logMAR = logarithm of the minimum angle of resolution; LMH = lamellar macular hole.

^*Paired t-test.

Table 3

Associations of final visual acuity with demographic and clinical variables by multiple linear regression analyses in the high myopia group

Values are presented as mean ± standard deviation unless otherwise indicated.

B = regression coefficient; SE = standard errors; R² = correlation of determination; logMAR = logarithm of the minimum angle of resolution

^*Multiple linear regression analyses.

Table 4

Differences of the demographic and clinical factors according to the presence of foveoschisis in the high myopia group

Values are presented as mean ± standard deviation unless otherwise indicated.

D = diopter; logMAR = logarithm of the minimum angle of resolution; LMH = lamellar macular hole.

^*Mann-Whitney U test; ^†Wilcoxon signed rank test.

Table 5

Differences of the demographic and clinical factors according to the degree of myopia in the high myopia group

Values are presented as mean ± standard deviation unless otherwise indicated.

D = diopter; logMAR = logarithm of the minimum angle of resolution; LMH = lamellar macular hole.

^*Mann-Whitney U test; ^†Wilcoxon signed rank test.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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