Outcomes of Pars Plana Vitrectomy With Membrane Peel for Lamellar Macular Holes and Related Conditions Using a New Optical Coherence Tomography Consensus Definition

Abstract

Purpose: To characterize the change in visual acuity (VA) in eyes treated with vitrectomy using the 2020 international consensus-based optical coherence tomography (OCT) definition of lamellar macular hole (LMH), macular pseudohole (MPH), and epiretinal membrane with foveoschisis (ERMF). Methods: A retrospective chart review was performed from 2000 to 2022 of patients who had vitrectomy for symptomatic decreased VA from LMH, MPH, or ERMF performed by the same surgeon at a community hospital. Preoperative spectral domain (SD-OCT) was reviewed to classify patients using the consensus guidelines. Primary outcomes were the mean change in best-corrected VA at 3 months, 1 year, and the final postoperative examination. Results: Fifty-one patients were included, 30 with LMH, 14 with MPH, and 7 with ERMF. The VA was 20/63 at baseline, 20/62 ( P = .79) 3 months postoperatively, 20/40 ( P = .003) at 1 year, and 20/52 ( P = .10) at the final examination for LMH; 20/64, 20/50 ( P = .16), 20/40 ( P = .040), and 20/40 ( P = .02), respectively, for MPH; and 20/53, 20/50 ( P = .42), 20/30 ( P = .03), and 20/38 ( P = .04), respectively, for ERMF. Subgroup analysis showed that eyes with LMH without ellipsoid zone disruption on SD-OCT improved from 20/57 at baseline to 20/39 ( P = .01) at the final examination. Conclusions: There was no significant improvement in VA at the final postvitrectomy examination in eyes with LMH, while there was significant improvement in eyes with MPH and ERMF. This supports surgery in selected eyes with MPH and ERMF but possibly not in eyes with LMH, unless OCT shows no ellipsoid zone disruption.