Effect of vitrectomy on full-thickness macular hole with lamellar hole-associated epiretinal proliferation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the visual improvement and anatomical closure of patients with full-thickness macular hole(FTMH)accompanied by lamellar hole-associated epiretinal proliferation(LHEP)after vitrectomy.METHODS: A retrospective study of clinical cases. A total of 28 cases(28 eyes)of patients diagnosed with FTMH in our hospital between January 2018 and January 2022 were included, and they were divided into 12 cases(12 eyes)in the LHEP group and 16 cases(16 eyes)in the non-LHEP group according to the presence or absence of LHEP. All subjects had undergone vitrectomy. The best corrected visual acuity(BCVA)before and 1a after operation, hole closure, continuity of ellipsoid zone and external limiting membrane(ELM), intraocular pressure(IOP), and postoperative complications were compared between the two groups.RESULTS: Preoperative BCVA(LogMAR)was 0.80±0.17 in the LHEP group and 0.92±0.27 in the non-LHEP group(t=1.406, P=0.172); BCVA at 1a after operation was 0.54±0.14 in the LHEP group and 0.39±0.10 in the non-LHEP group(t=3.399, P=0.002). BCVA at 1a after operation was significantly improved in both groups compared with that before operation(tLHEP group=4.029; PLHEP group=0.001; tnon-LHEP group=7.445, Pnon-LHEP group=0.001); the difference in BCVA(LogMAR)before and after the operation was 0.27±0.16 in the LHEP group and 0.52±0.26 in the non-LHEP group(t=3.153, P=0.002). The hole closed in both groups 1a after the operation, and the closure rate was 100%. The ellipsoid zone closed in 20%(2/12)of patients in the LHEP group and 56%(9/16)in the non-LHEP group(Pellipsoid zone=0.04); the ELM closed in 25%(3/12)of patients in the LHEP group and 69%(11/16)in the non-LHEP group(PELM=0.027). A postoperative transient IOP elevation occurred in 2 eyes of the LHEP group and 3 eyes of the non-LHEP group, respectively. There were no significant cataract or serious complications after the vitrectomy in either group.CONCLUSIONS: Compared with FTMH patients without LHEP, the BCVA improvement after vitrectomy was less in FTMH patients with LHEP. Although their macular hole was closed, the closure rates of ellipsoid zone and ELM were lower, and the duration of continuity interruption was longer, so the prognosis requires further clarification.

Diagnosis and treatment progress of lamellar hole-associated epiretinal proliferation / 中华眼底病杂志

The current understanding of lamellar hole-associated epiretinal proliferation (LHEP) is based on OCT examination. This preretinal proliferation is seen at the edge of the lamina macular hole (LMH) as a meso-reflective substance under linear strong reflection, located between the internal limiting membranes and the nerve fiber layer. LHEP is often associated with LMH, but its histological origin, morphology and OCT characteristics are different from LMH, and its visual prognosis is worse. At present, the relationship between the occurrence of LHEP and clinical prognosis is still under study. This article reviews the pathology, morphology, clinical features, diagnosis and treatment of LHEP, in order to enhance clinical understanding of this disease.

Characteristics of optical coherence tomography of lamellar hole-associated epiretinal proliferation / 中华眼底病杂志

Objective@#To observe the OCT characteristics of lamellar hole-associated epiretinal proliferation (LHEP).@*Methods@#A retrospective case analysis. A total of 128 patients (133 eyes) with lamellar macular hole (LMH) and 202 patients (212 eyes) with full-thickness macular hole (FTMH) diagnosed by the examinations of spectral-domain OCT (SD-OCT) in Department of Ophthalmology, The Third People's Hospital of Chengdu from January 2013 to December 2016 were included in this study. Among 133 eyes with LMH, there were 53 eyes (39.8%) with LHEP and 80 eyes (60.2%) without LHEP. Among 212 eyes with FTMH, there were 12 eyes (5.7%) with LHEP and 200 eyes (94.3%) without LHEP. The mean age of LMH with or without LHEP patients were 70.88±10.98, 64.76±13.60 years old, respectively. The difference of mean age between LMH with or without LHEP patients was statistically significant (U=1521.5, P=0.006). The inner diameter, median diameter and base thickness of the LMH, the height, base diameter and minimum diameter of FTMH were measured by SD-OCT. The traction index (THI) and the macular hole index (MHI) were calculated. An independent sample t-test or rank-sum test was used to compare the inner diameter, median diameter, and base thickness of the LMH in patients with or without LHEP, and χ2 test was used to compare the injury rate of ellipsoid zone.@*Results@#Of the LMH patients with or without LHEP, the inner diameter were 611.15±209.83 and 521.70±198.05 μm, the median diameter were 961.22±571.09 and 497.01±172.30 μm, the base thickness were 99.83±38.69 and 154.12±43.17 μm. The differences of the inner diameter, median diameter and the base thickness between LMH patients with or without LHEP were statistically significant (t=2.490, 5.747, -7.395; P=0.014, 0.000, 0.000). Among the 53 eyes with LHEP, There were 50 eyes (94.34%) were injured in ellipsoid zone among 53 eyes with LHEP, while 17 eyes (21.25%) were injured in ellipsoid zone among 80 eyes without LHEP. The injury rate of ellipsoid zone between LMH patients with or without LHEP was statistically significant (χ2=68.126, P=0.000). In 12 eyes of FTMH with LHEP, there were 10 eyes with THI <1.0 and MHI<0.5.@*Conclusion@#Compared with the LMH without LHEP, the LMH with LHEP has larger inner diameter and median diameter, thinner base and higher injury rate of ellipsoid zone.

Epiretinal Proliferation Associated with Lamellar Hole or Macular Hole: Origin and Surgical Prognosis

PURPOSE: To determine the origin of epiretinal proliferation (EP), a condition that is occasionally observed in lamellar hole and macular hole cases, and EP outcomes after vitrectomy. METHODS: This is a retrospective observational case review of 17 eyes with EP that underwent vitrectomy, EP dissection, and internal limiting membrane peeling between January 2013 and December 2016. Surgical specimens of EP tissue were successfully obtained from 5 cases and they were analyzed after immunohistochemical staining. Postoperative outcomes, including best-corrected visual acuity (BCVA) and macular configuration in spectral domain-optical coherence tomography, were reviewed. RESULTS: Mean BCVA improved from 0.54 ± 0.36 logarithms of the minimum angle of resolution preoperatively to 0.32 ± 0.38 logarithms of the minimum angle of resolution postoperatively (p = 0.002). BCVA improved in 13 eyes and remained unchanged in four eyes. No cases experienced vision decline after surgery. All 17 patients' lamellar hole or macular hole were successfully closed. Despite hole closure, ellipsoid zone defects were not corrected in 11 of the 17 patients. In immunohistochemical analyses, anti-glial fibrillary acidic protein and pan-keratin (AE1/AE3) were positive, but synaptophysin, anti-α-smooth muscle actin, and anti-CD68 were negative. CONCLUSIONS: The epiretinal proliferative membrane seems to originate from Müller cells, not from the vitreous. It is unclear whether retinal pigment epithelia also contribute to EP formation. Gentle handling and preservation of the epiretinal proliferative tissue is crucial for successful surgical outcomes.

Diagnosis and treatment progress of lamellar hole-associated epiretinal proliferation / 中华眼底病杂志

The current understanding of lamellar hole-associated epiretinal proliferation (LHEP) is based on OCT examination.This preretinal proliferation is seen at the edge of the lamina macular hole (LMH) as a meso-reflective substance under linear strong reflection,located between the internal limiting membranes and the nerve fiber layer.LHEP is often associated with LMH,but its histological origin,morphology and OCT characteristics are different from LMH,and its visual prognosis is worse.At present,the relationship between the occurrence of LHEP and clinical prognosis is still under study.This article reviews the pathology,morphology,clinical features,diagnosis and treatment of LHEP,in order to enhance clinical understanding of this disease.

Characteristics of optical coherence tomography of lamellar hole-associated epiretinal proliferation / 中华眼底病杂志

Objective To observe the OCT characteristics of lamellar hole-associated epiretinal proliferation (LHEP).Methods A retrospective case analysis.A total of 128 patients (133 eyes) with lamellar macular hole (LMH) and 202 patients (212 eyes) with full-thickness macular hole (FTMH) diagnosed by the examinations of spectral-domain OCT (SD-OCT) in Department of Ophthalmology,The Third People's Hospital of Chengdu from January 2013 to December 2016 were included in this study.Among 133 eyes with LMH,there were 53 eyes (39.8％) with LHEP and 80 eyes (60.2％) without LHEP.Among 212 eyes with FTMH,there were 12 eyes (5.7％) with LHEP and 200 eyes (94.3％) without LHEP.The mean age of LMH with or without LHEP patients were 70.88± 10.98,64.76± 13.60 years old,respectively.The difference of mean age between LMH with or without LHEP patients was statistically significant (U=1521.5,P=0.006).The inner diameter,median diameter and base thickness of the LMH,the height,base diameter and minimum diameter of FTMH were measured by SD-OCT.The traction index (THI) and the macular hole index (MHI) were calculated.An independent sample t-test or rank-sum test was used to compare the inner diameter,median diameter,and base thickness of the LMH in patients with or without LHEP,and x2 test was used to compare the injury rate of ellipsoid zone.Results Of the LMH patients with or without LHEP,the inner diameter were 611.15 ± 209.83 and 521.70± 198.05 μm,the median diameter were 961.22 ± 571.09 and 497.01 ± 172.30 μm,the base thickness were 99.83 ± 38.69 and 154.12± 43.17 μm.The differences of the inner diameter,median diameter and the base thickness between LMH patients with or without LHEP were statistically significant (t=2.490,5.747,-7.395;P=0.014,0.000,0.000).Among the 53 eyes with LHEP,There were 50 eyes (94.34％) were injured in ellipsoid zone among 53 eyes with LHEP,while 17 eyes (21.25％) were injured in ellipsoid zone among 80 eyes without LHEP.The injury rate of ellipsoid zone between LMH patients with or without LHEP was statistically significant (x2=68.126,P=0.000).In 12 eyes of FTMH with LHEP,there were 10 eyes with THI＜ 1.0 and MHI＜0.5.Conclusion Compared with the LMH without LHEP,the LMH with LHEP has larger inner diameter and median diameter,thinner base and higher injury rate of ellipsoid zone.

Epiretinal Proliferation Associated with Macular Hole and Intraoperative Perifoveal Crown Phenomenon

PURPOSE: To discuss the unique morphology and origin of epiretinal proliferation associated with macular hole (EPMH) occasionally observed in full-thickness macular hole (FT-MH) or lamellar hole (LH) and to introduce the perifoveal crown phenomenon encountered when removing this unusual proliferative tissue. METHODS: Sixteen patients showing EPMH in spectral domain-optical coherence tomography were selected from 212 patients diagnosed with MH, LH, FT-MH, impending MH, macular pseudohole, or epiretinal membrane between January 2013 and December 2014. Of the 212 patients included for clinical analysis, 33, 23, 11, 7, and 190 exhibited LH, FT-MH, impending MH, macular pseudohole, and epiretinal membrane, respectively. We reviewed visual acuity, macular morphology, and clinical course. Surgical specimens were analyzed histologically. RESULTS: EPMH presented as an amorphous proliferation starting from the defective inner/outer segment (IS/OS) junction covering the inner macula surface. Among the 16 patients with EPMH, 11 underwent vitrectomy, and all exhibited the intraoperative perifoveal crown phenomenon. EPMH tissue was sampled in three patients, one of whom had more tissue removed than intended and showed delayed recovery in visual acuity. Despite hole closure, IS/OS junction integrity was not successfully restored in four of 11 patients. Five patients were followed-up without surgical intervention. Visual acuity slightly decreased in three patients and did not change in one patient, while the remaining patient was lost during follow-up. Among the three perifoveal crown tissues obtained, two were successfully analyzed histologically. Neither tissue showed positivity to synaptophysin or S-100 protein, but one showed positivity to cytokeratin protein immunohistochemical staining. CONCLUSIONS: EPMH exhibited a distinct but common configuration in spectral domain-optical coherence tomography. An epithelial proliferation origin is plausible based on its configuration and histological analysis. Perifoveal crown phenomenon was observed when removing EPMH during vitrectomy.