Anatomic and Functional Outcomes of Lamellar Macular Hole and Epiretinal Membrane Foveoschisis Surgery: Predictive Factors and Associated Complications — A Retrospective Interventional Study

Abstract

Purpose: To analyze the anatomic and functional outcomes of lamellar macular hole (LMH) and epiretinal membrane foveoschisis (ERMF) surgery. Patients and Methods: This is a retrospective interventional cohort study of ninety patients with unilateral idiopathic LMH or ERMF who underwent pars plana vitrectomy (PPV) with membrane peeling between 2014 and 2021. We evaluated the anatomic and functional success of PPV with membrane peeling for treating LMH and ERMF, compared surgical outcomes between the two entities, and identified predictive factors for anatomical and functional success. Primary outcomes included final postoperative best-corrected visual acuity (BCVA) and LMH or ERMF closure. Variables associated with final BCVA were assessed using a multiple linear regression model. Results: 51 subjects presented with ERMF, while 39 presented with LMH. LMH or ERMF closure occurred in 80 cases. LMH cases had a lower rate of closure (LMH closure rate: 76.9%, vs ERMF closure rate: 98.0%, p=0.002) 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] logMAR) and final BCVA (0.31 [0.14, 0.48] logMAR, p=0.024). BCVA varied from 0.52 [0.40, 0.74] logMAR preoperatively to 0.36 [0.30, 0.66] logMAR postoperatively in the LMH subgroup (p=0.060), and from 0.32 [0.20, 0.54] logMAR preoperatively to 0.22 [0.10, 0.40] logMAR postoperatively in the ERMF subgroup (p=0.146). LMH without epiretinal proliferation (β=0.194, p=0.040) was associated with worse final BCVA in multivariate analysis. Conclusion: Results support the effectiveness of PPV as a treatment for LMH. LMHs had worse anatomic outcomes than ERMFs.