Université de Paris, Ophthalmology Department, AP-HP, Hospital Lariboisière, Paris, France.
Retina Division, Stein Eye Institute, University of California, Los Angeles, California.
Ophthalmol Retina. 2021 Oct;5(10):1009-1016. doi: 10.1016/j.oret.2020.12.023. Epub 2021 Jan 5.
To describe the clinical features and surgical outcomes of patients experiencing a spontaneous conversion of a lamellar macular hole (LMH) to a full-thickness macular hole (FTMH).
Retrospective, multicenter, observational case series.
Patients with LMH who experienced a spontaneous conversion to FTMH and underwent FTMH surgery.
Clinical charts and OCT features of 20 eyes of 20 patients were reviewed.
OCT features and surgical outcomes of FTMH derived from LMH.
The mean baseline visual acuity (VA) was 0.21 ± 0.19 logarithm of the minimum angle of resolution (logMAR) (20/32 Snellen equivalent [SE]). Epiretinal proliferation was noted in 18 eyes (90%), and 14 eyes (75%) had an epiretinal membrane. At the diagnosis of FTMH, the mean VA decreased to 0.61 ± 0.50 logMAR (20/81 SE) (P = 0.001). The mean FTMH diameter was 224.4 ± 194.8 μm, with 15 (75%) small (≤250 μm), 2 (10%) medium (>250-≤400 μm), and 3 (15%) large (>400 μm) FTMHs. Eighteen (90%) FTMHs were sealed after 1 surgery, and 2 (10%) required an additional procedure. At the last follow-up, the mean VA was increased to 0.29 ± 0.23 logMAR (20/38 SE) (P = 0.003), but did not significantly differ from the baseline VA (P = 0.071).
Patients with LMH may develop an FTMH with no evidence of vitreomacular traction. A tangential traction from an epiretinal membrane may contribute to its genesis, but a progressive loss of retinal tissue and an inherent weakness of the foveal architecture in LMH eyes could be sufficient. Most FTMHs derived from LMH had a small diameter, showed epiretinal proliferation, showed limited retinal hydration, and were associated with relatively poor surgical outcomes compared with idiopathic FTMH.
描述板层黄斑裂孔（LMH）自发转化为全层黄斑裂孔（FTMH）患者的临床特征和手术结果。
回顾性、多中心、观察性病例系列。
LMH 患者经历自发转化为 FTMH 并接受 FTMH 手术。
回顾 20 名患者 20 只眼的临床图表和 OCT 特征。
源自 LMH 的 FTMH 的 OCT 特征和手术结果。
平均基线视力（VA）为 0.21±0.19 对数最小角分辨率（logMAR）（20/32 Snellen 等效[SE]）。18 只眼（90%）存在视网膜内增殖，14 只眼（75%）有视网膜内膜。在 FTMH 的诊断时，平均 VA 下降至 0.61±0.50 logMAR（20/81 SE）（P=0.001）。平均 FTMH 直径为 224.4±194.8μm，其中 15 只（75%）小（≤250μm），2 只（10%）中（>250-≤400μm），3 只（15%）大（>400μm）FTMH。18 只（90%）FTMH 在 1 次手术后封闭，2 只（10%）需要额外手术。在最后一次随访时，平均 VA 增加至 0.29±0.23 logMAR（20/38 SE）（P=0.003），但与基线 VA 无显著差异（P=0.071）。
LMH 患者可能会出现无玻璃体黄斑牵引的 FTMH。来自视网膜内膜的切线牵引可能有助于其发生，但 LMH 眼内视网膜组织的逐渐丧失和固有黄斑中心凹结构的薄弱可能就足够了。与特发性 FTMH 相比，源自 LMH 的大多数 FTMH 直径较小，表现出视网膜内增殖，显示出有限的视网膜水肿，并且与相对较差的手术结果相关。
