A recent study analyzed patients who underwent full-thickness macular hole surgery due to spontaneous conversion from lamellar macular holes and found that macular hole size influences surgical outcomes.

The retrospective, multicenter, observational case series reviewed OCT features and surgical outcomes of 20 eyes of 20 patients. The participants’ mean baseline visual acuity was 0.21logMAR (20/32). The researchers noted epiretinal proliferation in 90% of eyes and epiretinal membranes in 75%. When diagnosed with a full-thickness macular hole, patients’ mean visual acuity significantly decreased to 0.61logMAR (20/81).

The mean diameter of full-thickness macular holes was 224.4μm. Most of the holes (75%) were small—less than or equal to 250μm—but 10% were between 250µm and 400μm and 15% were greater than 400μm.

After one surgery, 90% of the full-thickness macular holes sealed. Two holes required an additional procedure. At the final follow-up, the mean visual acuity increased significantly to 0.29logMAR (20/38) from baseline.

The researchers concluded that lamellar macular holes may progress to full thickness in the absence of vitreomacular traction. Tangential traction from an epiretinal membrane may be a contributing factor, they noted, but more likely causes include progressive loss of retinal tissue and inherent weakness in the foveal architecture of eyes with lamellar macular holes. “Most full-thickness macular holes derived from lamellar macular holes had a small diameter, showed epiretinal proliferation, limited retinal hydration and were associated with relatively poor surgical outcomes compared with idiopathic full-thickness macular holes,” they wrote in their paper.

Chehaibou I, Hubschman J, Kasi S, et al. Spontaneous conversion of lamellar macular holes to full-thickness macular holes: clinical features and surgical outcomes. Ophthalmology. January 4, 2021. [Epub ahead of print].