Kshitiz Kumar1, Tushar Kanti Sinha2, Debashish Bhattacharya2. 1. Vitreo-Retina Consultant, DISHA Eye Hospital, 88(63A), Ghoshpara Road, Barrackpore, Kolkata, 700120, West Bengal, India. kshitiz_k@rediffmail.com. 2. Vitreo-Retina Consultant, DISHA Eye Hospital, 88(63A), Ghoshpara Road, Barrackpore, Kolkata, 700120, West Bengal, India.
Abstract
PURPOSE: To evaluate the efficacy and safety of lamellar hole-associated epiretinal proliferation embedding technique with modification in the surgical management of degenerative lamellar macular hole (LMH). METHODS: There is retrospective case series of consecutive eyes who underwent pars plana vitrectomy with LHEP embedding with internal limiting membrane (ILM) inversion technique for degenerative LMH. Primary outcome measure was improvement in foveal contour and central foveal thickness (CFT). Secondary outcome measures were changes in best corrected visual acuity (BCVA), status of outer retinal layers (external limiting membrane-ELM & ellipsoid zone-EZ) and complications. RESULTS: Ten eyes were operated by modified LHEP embedding technique. Mean age was 65.8 ± 5.3 years with 1:1 male to female ratio. Simultaneous cataract surgery was done in 70% cases. Mean follow-up duration was 7.9 ± 0.87 months. 80% (8/10) eyes had improvement in foveal contour to normal appearance with increase in residual foveal thickness from 90.2 ± 26.83 microns to CFT of 226 ± 35.44 microns at 6 months (p = 0.0054). Mean BCVA improved from 0.69 ± 0.19 logMAR to 0.32 ± 0.29 logMAR (p = 0.012). External limiting membrane (ELM) and ellipsoid zone (EZ) defects were present in four eyes (40%) pre-operatively. At the final visit 2 eyes (20%) had persistent defect in both ELM & EZ. None of the eyes progressed to full-thickness macular hole following surgery. CONCLUSIONS: The modified surgical technique of LHEP Embedding with ILM inversion is demonstrated to provide satisfactory results with reduced risk of complications for degenerative LMH. Larger and long-term follow-up studies are needed to establish this technique as standard surgical procedure for LMH with LHEP.
PURPOSE: To evaluate the efficacy and safety of lamellar hole-associated epiretinal proliferation embedding technique with modification in the surgical management of degenerative lamellar macular hole (LMH). METHODS: There is retrospective case series of consecutive eyes who underwent pars plana vitrectomy with LHEP embedding with internal limiting membrane (ILM) inversion technique for degenerative LMH. Primary outcome measure was improvement in foveal contour and central foveal thickness (CFT). Secondary outcome measures were changes in best corrected visual acuity (BCVA), status of outer retinal layers (external limiting membrane-ELM & ellipsoid zone-EZ) and complications. RESULTS: Ten eyes were operated by modified LHEP embedding technique. Mean age was 65.8 ± 5.3 years with 1:1 male to female ratio. Simultaneous cataract surgery was done in 70% cases. Mean follow-up duration was 7.9 ± 0.87 months. 80% (8/10) eyes had improvement in foveal contour to normal appearance with increase in residual foveal thickness from 90.2 ± 26.83 microns to CFT of 226 ± 35.44 microns at 6 months (p = 0.0054). Mean BCVA improved from 0.69 ± 0.19 logMAR to 0.32 ± 0.29 logMAR (p = 0.012). External limiting membrane (ELM) and ellipsoid zone (EZ) defects were present in four eyes (40%) pre-operatively. At the final visit 2 eyes (20%) had persistent defect in both ELM & EZ. None of the eyes progressed to full-thickness macular hole following surgery. CONCLUSIONS: The modified surgical technique of LHEP Embedding with ILM inversion is demonstrated to provide satisfactory results with reduced risk of complications for degenerative LMH. Larger and long-term follow-up studies are needed to establish this technique as standard surgical procedure for LMH with LHEP.
Authors: Andreas Bringmann; Jan Darius Unterlauft; Renate Wiedemann; Thomas Barth; Matus Rehak; Peter Wiedemann Journal: Int Ophthalmol Date: 2021-01-12 Impact factor: 2.031