Deciding when to observe, operate on lamellar macular holes
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NEW YORK – Lamellar macular holes may lead to progressive vision loss, but not all patients will need surgery, according to a speaker here.
Stanley Chang, MD, said lamellar macular holes (LMH) recently got a new classification allowing for better definition using optical coherence tomography.
“I think there’s been some controversies about how to manage lamellar macular holes and this primarily arises from some confusion in how the diagnosis is made based on OCT examinations,” Chang said during OSN New York Retina 2021.
With LMH, the retina is minimally thickened, and epiretinal proliferation causes minimal traction and contains carotenoids. While some patients may progress, vitrectomy is not needed in most, Chang said.
In one study that followed 48 eyes for more than 38 months found that there was no significant change in best corrected visual acuity. In another comprising 62 eyes, just 3 had functional decline of 0.3 logMar over a follow-up of more than 26 months.
Chang said there are several indications to change management of these patients from observation to surgery, including progression to full thickness macular hole or progressive, debilitating vision loss.
In a review of 340 eyes for macular epiretinal membrane or macular hole between 2009 and 2015, just three underwent vitrectomy.
“The new OCT features of the LMH are definitely better defined with this new classification,” Chang said. “I tend to operate if there is progressive vision loss or if a full-thickness macular hole develops.”
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Chang S., et al. Lamellar macular holes: When should we operate and when to observe. Presented at: OSN New York and OSN New York Retina; Oct. 15-17, 2021; New York.
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