SCIENTIFIC POSTER 2016_A Wrong Decision Surgery of Lamellar Retinal Hole (A Case Report) Lidmila Prochazkova

Objective:

Our case report presents the course of a lamellar hole surgery and subsequent macular hole surgeries in a female patient aged 56 years.

Introduction:

Macular hole is a fovea defect in full thickness. It is caused by both tangential and saggital traction of posterior hyaloid in macular area. Macular hole progressively expands, with cystoid edema at the edges, edges start lifting and beneath them appears subretinal liquid. Macular holes are classified into 4 stages, while surgeries are usually undertaken from the 2nd stage up. Lamellar hole originates from spontaneous detachment of vitreous body from retina and from releasing tangential traction. The macular hole does not develop fully through the retina, but its outer layers remain. Usually one can find a cyst in macula preceding the progress of lamellar hole. Lamellar hole is classsifed within the 1st stage of macular holes and does not require surgery, unless subjective difficulties intensify or the finding progresses.

Methods and results:

Following a cataract surgery we recorded in our 56-year-old patient an unimproved visual acuity in her better right eye and discovered a lamellar hole. She requested a surgery as soon as possible. On July 6th, 2015 she underwent a pars plana vitrectomy with an ILM (internal limiting membrane) peeling, sulphur hexafluoride and face down position. The following check on July 8th, 2015 revealed a full thickness macular hole and visual acuity 1/30. Therefore we proceeded with another surgery – vitrectomy, ERM peeling, silicone oil 1300 & face down position. On August 3rd, 2015 the macular hole was not closed, yet the edges were attached, visual acuity 2/30. On December 3rd, 2015 we removed the silicone oil and when checking the situation on December 12, 2015, we recorded that the edges were attached, but the distance between edges increased and visual acuity gave 1/30.

Take home message:

When diagnosing lamellar hole it is highly recommended to only observe the patient and to proceed with a surgical intervention unless the visual acuity deteriorates, the patient reports subjective difficulties (metamorphopsia) and the lamellar hole expands. Other authors have also reported full-thickness macular hole after lameelar macular hole surgery and therefore it is important to warn patients before surgeries of lamellar defects about this possible complication and , recommend surgery only in case of worsening visual acuity or symptoms progression. It is essential not let the patient persuade us into the surgery, unless we are fully convinced about it ourselves!

Contact Details:

Email: lidmila.prochazkova@kzcr.eu
Cell Phone: +420604710118

Lidmila Prochazkova