Anatomic and Functional Outcomes of Lamellar Macular Hole Surgery: Predictive Factors and Associated Complications

PurposeTo analyze the anatomic and functional outcomes of lamellar macular hole (LMH) surgery. Patients and methodsThis is a retrospective interventional cohort study of ninety patients with unilateral idiopathic LMH who underwent pars plana vitrectomy (PPV) with membrane peeling for LMH between 2014 and 2021. We evaluated the anatomic and functional success of PPV with membrane peeling for treating LMH, compared surgical outcomes between the two LMH subtypes ("true" LMH and epiretinal foveoschisis (ERMF)), and identified predictive factors for anatomical and functional success. Primary outcomes included final postoperative best-corrected visual acuity (BCVA) and LMH closure. Variables associated with final BCVA were assessed using a multiple linear regression model. Results51 subjects presented with ERMF, while 39 presented with "true" LMH. LMH closure occurred in 80 cases. "True" LMH cases had a lower rate of closure ("true" LMH closure rate: 76.9%, vs. ERMF closure rate: 94.2%, p=0.005) and were more at risk of developing a postoperative macular hole (p=0.008). A significant difference was observed between median [Q1, Q3] preoperative BCVA (0.42 [0.26, 0.61]) and final BCVA (0.31 [0.14, 0.48], p=0.024). "True" LMH without epiretinal proliferation ({beta}=0.194, p=0.040) was associated with worse final BCVA in multivariate analysis. ConclusionResults support the effectiveness of PPV as a treatment for LMH. "True" LMHs had worse anatomic outcomes than ERMFs.