Advantages:

To analyze the evolution of idiopathic partial thickness macular holes (lamellar macular holes (LMH) and macular pseudoholes (MPH)) in the long term, based on Optical Coherence Tomography (OCT) configuration and on Best Corrected Visual Acuity (BCVA) evolution, and, based on it, to determine the therapeutic implications.

Methods:

A prospective, observational study that includes patients with diagnosis of idiopathic LMH and/or MPH. Those patients with presence of cataract with functional repercussion in the first examination, and those phakic patients with cataract progression during the follow-up period, underwent cataract surgery. Those patients with diminution of BCVA not attributable to other causes and/or metamorphopsia underwent vitreoretinal surgery. The main analyzed variables were: lens status, metamorphopsia, BCVA, and tomographic characteristics. Statistical significance was considered as a p-value of p equal or less than 0.05.

Effectiveness / Safety:

100 eyes of 88 patients were analyzed, with a mean follow-up period of 34.08 ±1.52 months. 16 eyes underwent vitrectomy (due to diminution of BCVA not attributable to cataract progression: 14 eyes, or due to metamorphopsia: 2 eyes), and the remaining 84 eyes were observed. 32 eyes of the total sample underwent cataract surgery. Regarding BCVA, we appreciated significant improvement in those eyes that underwent cataract surgery, and it showed no changes in the remaining eyes. The 16 patients who underwent vitrectomy obtained a significant improvement in their BCVA. Regarding tomographic characteristics: we did not observe statistically significant differences in size in those patients on whom we performed observation. In those eyes that underwent vitrectomy, closure of the defect was found in 14 cases. The presence of epiretinal membranes and posterior vitreous detachment were frequent findings, and they remained unchanged during the follow-up period. We observed macular pathology in the fellow eye of 17 patients.

In conclusion:

Those patients with partial-thickness macular defects and cataract can undergo lens extraction, and this allows improvement in visual acuity. Vitreoretinal surgery should be only performed in those cases with diminution in BCVA not attributable to cataract or in those with disabling metamorphopsia.