Natural evolution of idiopathic lamellar macular holes

Purpose To analize the natural course of patients with idiopathic lamellar macular hole (LMH), based on their optical coherence tomography (OCT) configuration and visual prognosis. Methods A retrospective observational case series study was performed, in 19 eyes (17 patients) over a period of 5 years. A number of factors were analized, including: best visual corrected acuity (BVCA), refractive error, lens status, presence of epirretinal membranes (ERM) and other alterations identified by OCT, and the size of the lamellar defects (diameter, residual foveal thickness, perifoveal thickness). Results Most of them were unilateral defects, and were found in elderly women. More than 50% were found to be myopic patients and 90% of them had cataracts. Fifty- per cent of all lamellar defects had an associated ERM. Other alterations like vitreomacular traction syndrome and posterior vitreous detachment were less frequent. No significant differences were found regarding size of the lamellar defects, nor BCVA during the follow-up period (p>0.05), except those who underwent cataract surgery, who experienced a significant increase of their BCVA (p<0.05), and one patient who developed a full-thickness macular hole. The presence of ERM was significantly correlated with greater residual foveal thickness (p<0.05). Conclusion According to our study, most of LMH do not progress, and they do not contribute to a diminished BCVA. Frequently, LMH are associated with cataracts and ERM. Hence, a reduction in BCVA in these patients can be related to the mentioned concomitant eye diseases, and should be taken into account before surgery.