Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei City, Taiwan.
Graefes Arch Clin Exp Ophthalmol. 2024 Aug;262(8):2713-2724. doi: 10.1007/s00417-024-06419-8. Epub 2024 Feb 26.
Lamellar macular holes (LMHs) are a manifestation of myopic tractional maculopathy (MTM). Owing to the complex and multidirectional traction force in the elongated eyeball, the clinical features, development, evolution, and treatment algorithms of LMH in highly myopic eyes may differ from those of idiopathic LMH or MTM in general. This review aimed to specifically explore the LMHs in highly myopic eyes. Several developmental processes of LMH and their association with macular retinoschisis have been demonstrated, with the tractional component identified in all processes. Epiretinal proliferation was more prevalent and more extensive in LMHs in highly myopic eyes than in idiopathic LMHs. LMHs in highly myopic eyes may remain stable or progress to foveal detachment and full-thickness macular hole with or without retinal detachment. The predictive factors associated with disease progression were summarized to facilitate monitoring and guide surgical intervention. The treatment of LMHs in highly myopic eyes was based on an algorithm for treating myopic tractional maculopathy, including gas tamponade, pars plana vitrectomy, macular buckling, and a combination of vitrectomy and macular buckling. New internal limiting membrane (ILM) manipulation techniques such as fovea-sparing ILM peeling or fovea-sparing ILM peeling combined with ILM flap insertion could reduce the risk of developing iatrogenic full-thickness macular holes postoperatively. Further research should focus on the treatment of LMH in highly myopic eyes.
层状黄斑裂孔（LMH）是近视牵引性黄斑病变（MTM）的一种表现。由于长眼球中存在复杂且多方向的牵引力，高度近视眼中 LMH 的临床特征、发展、演变和治疗方案可能与特发性 LMH 或一般 MTM 不同。本综述旨在专门探讨高度近视眼中的 LMH。已经证明了 LMH 的几个发展过程及其与黄斑劈裂的关系，所有过程中都确定了牵引成分。在高度近视眼中，视网膜前膜增殖比特发性 LMH 更常见且更广泛。高度近视眼中的 LMH 可能保持稳定，也可能进展为中心凹脱离和全层黄斑裂孔，伴或不伴视网膜脱离。总结了与疾病进展相关的预测因素，以方便监测并指导手术干预。高度近视眼中 LMH 的治疗基于治疗近视牵引性黄斑病变的算法，包括气体填充、经睫状体平坦部玻璃体切除术、黄斑扣带术以及玻璃体切除术和黄斑扣带术的联合治疗。新的内界膜（ILM）处理技术，如保留中心凹的 ILM 剥离或保留中心凹的 ILM 剥离联合 ILM 瓣插入，可降低术后发生医源性全层黄斑裂孔的风险。进一步的研究应集中在高度近视眼中 LMH 的治疗上。
