Name

Chirurgie du trou lamellaire: analyse des résultats anatomiques et fonctionnels

The aim of this study is to analyze the anatomical and functional results of lamellar macular hole surgery and to assess in which lamellar macular hole cases the surgery has the best prognosis.

A retrospective observational study was conducted on 97 patients operated for unilateral lamellar macular hole (LMH) between 2014 and 2021 at the CUO-CHU de Quebec - Université Laval. Patient that had less than 3 months of follow-up were excluded. The primary outcome was final postoperative best-corrected visual acuity (BCVA) . Preoperative characteristics, surgical modalities, and anatomical changes in optical coherence tomographies (OCT) were also collected. A multiple linear regression model was constructed to assess which variables were predictive of final BCVA. 

63 of the 97 patients (64.9%) presenting a LMH were women and 34 were men (35.1%). Mean age at surgery was 70±9 years. Most patients (n=93, 95.9%) also had a concomitant epiretinal membrane (ERM) at the initial presentation. Eleven patients (11.3%) had a history of age-related macular degeneration (AMD). All the patients underwent 25-gauge pars plana vitrectomy (PPV) (n=97,100%), with most (n=78, 80.4%) undergoing concurrent ERM and internal limiting membrane (ILM) peel. Most patients (n=62, 63.9%) had SF6 gas as tamponade agent. There was a 89.7% (n=87) success rate of postoperative LMH closure. A significant difference was observed between median [Q1, Q3]   preoperative BCVA (0.42 [0.26, 0.61]) and final BCVA (0.31 [0.14, 0.49]) (p=0.023). All preoperative variables were evaluated through a multiple linear regression model. The model has suggested that gender (β=0.223; p=0,017), age at presentation (β=0.246; p=0.013), SF6 gas tamponade (β=0.211; p=0.025), preoperative ERM (β=-0.233; p=0.013) and history of AMD (β=0.275; p=0.004) were the predictors of final BCVA.

Results indicate that LMH surgery improves patients’ visual acuity. OCT imaging has shown that macular defects tend to decrease postoperatively. Masculine sex, older age, history of AMD and use of SF6 gas tamponade are factors associated with poorer final BCVA. On the other hand, the presence of a preoperative ERM suggests better surgical outcomes. 

Our study permitted us to conclude that LMH surgery improves visual acuity and foveal morphology; and assessed which factors were associated with final BCVA. Compared to prior reports on the subject, our sample size is one of the largest.