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Characterization of Epiretinal Proliferation in Full-Thickness Macular Holes and Effects on Surgical Outcomes

Esther Lee Kim1, Adam J Weiner2, Cindy Ung1

  • 1Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.

Ophthalmology. Retina
|May 21, 2019
PubMed
Abstract

Insights

Macular hole-associated epiretinal proliferation (MHEP) is linked to poorer surgical outcomes in full-thickness macular holes (FTMH). Internal limiting membrane peeling may improve closure rates in eyes with MHEP.

Area of Science:

  • Ophthalmology
  • Retinal Surgery
  • Macular Diseases

Background:

  • Epiretinal proliferation (EP) is distinct from epiretinal membrane, often associated with lamellar macular holes.
  • The prevalence and impact of EP on full-thickness macular holes (FTMH) remain underexplored.

Purpose of the Study:

  • To characterize macular hole-associated epiretinal proliferation (MHEP).
  • To evaluate the effects of MHEP on long-term surgical outcomes for FTMH.

Main Methods:

  • Retrospective case-control study of 113 eyes undergoing FTMH surgery.
  • Pars plana vitrectomy with or without internal limiting membrane (ILM) peeling.
  • Pre- and post-operative spectral-domain OCT imaging.

Main Results:

  • MHEP was present in 26.5% of FTMH cases, associated with older patients and more advanced hole stages.
  • FTMH with MHEP showed significantly less visual acuity improvement and higher rates of closure failure (26.7% vs. 4.8%).
  • Internal limiting membrane (ILM) peeling improved hole closure rates in MHEP eyes.

Conclusions:

  • FTMH with MHEP have poorer anatomic and visual outcomes post-vitrectomy.
  • ILM peeling is associated with better closure rates and should be considered in MHEP cases.

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