• Comprehensive Ophthalmology

    This study's authors prospectively followed patients with lamellar macular holes and highly myopic eyes and found the condition to be relatively stable, with only one of 24 eyes progressing to a full-thickness macular hole and worsening vision. They recommend performing surgery only if other findings indicate a course different from the natural course.

    Subjects in the study were 21 consecutive patients (24 eyes) with a lamellar macular hole and high myopia (myopic refractive error greater than 8 D or axial length of at least 26.5 mm). At the initial examination, an epiretinal membrane was identified by optical coherence tomography (OCT) in 17 of the eyes (70.8 percent), and seven eyes (29.2 percent) had macular retinoschisis. Subjects were followed for at least 12 months.

    OCT images for 23 eyes (95.8 percent) did not show any lamellar macular hole changes during a mean follow-up of 19.2 ± 10.2 months. The one eye that progressed to a full-thickness macular hole experienced decreased vision at 17 months. Pars plana vitrectomy was required to close the hole. Best-corrected visual acuity (BCVA) was maintained (within 0.2 logMAR) during the follow-up period in the remaining eyes. BCVA was 0.12 ± 0.16 logMAR units (range, -0.18 to 0.40 logMAR units) at the initial visit and was 0.12 ± 0.17 logMAR units (range, -0.18 to 0.52 logMAR units) at the final visit, which was not significantly different.

    The authors say that because an epiretinal membrane was observed in 71 percent (17/24) of the eyes, an epiretinal membrane with vitreal traction may be an important cause of lamellar macular hole in highly myopic eyes. They say that the study's findings suggest that the tractional force on the retinal surface in combination with hyaloidal traction in the anteroposterior direction leads to the development of lamellar macular hole as in full-thickness macular hole. They suggest that the mechanism that causes lamellar macular holes may be the same in highly myopic eyes as in nonmyopic eyes.

    The authors conclude that the progression from a lamellar macular hole to a full-thickness macular hole in only one of 17 eyes (5.9 percent) with an epiretinal membrane suggests that the presence of an epiretinal membrane might not facilitate the progression of lamellar macular holes. Likewise, they say that the lack of progression among the eyes with lamellar macular hole and macular retinoschisis suggests that the natural course of lamellar macular hole might not be affected by an accompanying macular retinoschisis.