Shpak A A, Shkvorchenko D O, Vedernikova O Yu, Shahabutdinova P M
S.N. Fyodorov National Medical Research Center «MNTK «Eye Microsurgery», Moscow, Russia.
Vestn Oftalmol. 2020;136(4):5-10. doi: 10.17116/oftalma20201360415.
The issue of indications for surgical treatment of lamellar macular holes (LMH) remains debatable, especially considering the different opinions about the possibility of their progression.
To study natural course of LMH and to develop criteria of their progression.
The study analyses retrospective data of patients with LMH observed in S. Fyodorov Eye Microsurgery Federal State Institution from 2013 to 2018 who were examined by optical coherence tomography (OCT) at least 2 times with an interval between the initial and last examinations of at least 6 months. The examinations were carried out to evaluate the types of LMH and epiretinal membrane, the ellipsoid zone of photoreceptors and vitreoretinal interface, as well as calculate the changes in the quantitative parameters of the LMH.
One hundred and three patients with LMH were identified; data of 65 patients (65 eyes) was studied in detail. The follow-up lasted 20.5±12.9 months on average. Statistically substantiated criteria for the progression of tractional and degenerative LMH were developed, taking into account the OCT changes most significant for each type of LMH. According to the proposed criteria, signs of marked progression were found in 2 (5.3%) of 38 patients with tractional and 4 (14.8%) of 27 patients with degenerative LMH. Moderate progression was detected in 2 (5.3%) patients with tractional and 2 (7.4%) patients with degenerative LMH. In two patients who were not included in the groups for calculating the criteria for progression, the formation of a full-thickness macular hole has occurred.
One of the variants of the natural course of LMH can be its progression up to transition into a full-thickness macular hole. The proposed statistically substantiated criteria allows identifying dangerous progression of LMH, which should be taken into account when determining the treatment tactics.
板层黄斑裂孔（LMH）手术治疗的适应证问题仍存在争议，尤其是考虑到关于其进展可能性的不同观点。
研究LMH的自然病程并制定其进展标准。
本研究分析了2013年至2018年在俄罗斯联邦国家机构圣·费奥多罗夫眼显微外科研究所观察到的LMH患者的回顾性数据，这些患者至少接受了2次光学相干断层扫描（OCT）检查，初次检查和末次检查之间的间隔至少为6个月。进行这些检查以评估LMH和视网膜前膜的类型、光感受器的椭圆体带和玻璃体视网膜界面，以及计算LMH定量参数的变化。
共识别出103例LMH患者；详细研究了65例患者（65只眼）的数据。平均随访时间为20.5±12.9个月。考虑到每种类型LMH最显著的OCT变化，制定了有统计学依据的牵引性和退行性LMH进展标准。根据提出的标准，38例牵引性LMH患者中有2例（5.3%）出现明显进展迹象，27例退行性LMH患者中有4例（14.8%）出现明显进展迹象。在2例牵引性LMH患者（5.3%）和2例退行性LMH患者（7.4%）中检测到中度进展。在未纳入进展标准计算组的2例患者中，出现了全层黄斑裂孔。
LMH自然病程的一种可能情况是进展直至转变为全层黄斑裂孔。所提出的有统计学依据的标准有助于识别LMH的危险进展，在确定治疗策略时应予以考虑。
