Surgical Repair of Spontaneous Full-Thickness Macular Holes Can Improve Visual Acuity

While lamellar macular holes may evolve spontaneously to full-thickness macular holes, surgery can return visual acuity to preoperative levels.

Lamellar macular holes may spontaneously progress to full-thickness macular holes, which can be addressed via surgery to improve visual acuity to presurgical levels, according to research published in Ophthalmology Retina. 

Researchers conducted a retrospective, multicenter, observational case series study to examine the clinical features of eyes that experienced spontaneous conversion of lamellar macular holes to full-thickness macular holes. The research team also sought to identify the possible underlying mechanisms of this process, and to evaluate surgical outcomes. 

Both medical records and spectral domain optical coherence tomography (SD-OCT) scans for patients who underwent pars plana vitrectomy for full-thickness macular holes derived from lamellar macular holes at multiple international tertiary care were reviewed. All patients included in the study were diagnosed with lamellar macular homes, experienced spontaneous full-thickness macular hole conversion during the follow-up period and underwent full-thickness macular hole surgery. 

In total, 20 eyes from 20 patients (12 women; mean age, 68.5 ± 9.0 years) were included. At the time of lamellar macular hole diagnosis, 90% of eyes and experienced epiretinal proliferation and 70% of eyes had an epiretinal membrane. Full-thickness macular hole conversion was identified after a mean follow-up duration of 8.3 (± 13.6) months. 

Twenty percent of patients had cataract surgery after lamellar macular hole diagnosis, but 13.9 (± 15.1) months before full-thickness macular hole diagnosis. Among participants, 75% noted “subjective functional changes” when full-thickness macular hole conversion occurred; mean visual acuity decreased from 0.21(±0.19) to 0.61(±0.50). 

Full-thickness macular hole mean aperture size was 224.4  µm (± 194.8  µm), with the majority of eyes classified as having a small (≤250 µm) hole. 

All 20 eyes underwent 25-gauge pars plana vitrectomy; 18 underwent internal limiting membrane peeling and 18 underwent epiretinal proliferation peeling. All had gas tamponade with either sulfur hexafluoride, perfluoroethane, or perfluoropropane. For 90% of eyes, the macular holes were closed after primary vitrectomy. In 2 eyes, the full-thickness macular hole did not close after the first procedure, and a second procedure was needed to achieve this outcome. After a mean follow-up of 12.3 (± 19.3) months, visual acuity increased to 0.29 (± 0.23) LogMAR, and was “significantly improved” compared with preoperative, but not baseline, visual acuity. 

Study limitations include the small sample size, an inability to utilize OCT examination before the development of full-thickness macular holes, and a nonhomogeneous follow-up period between patients, leading to a possible underestimation of postoperative visual outcomes. 

“[Lamellar macular holes] may evolve spontaneously to [full-thickness macular holes],” the researchers concluded. “Surgery may be used to close this secondary macular hole and improve vision to the initial level before the occurrence of the [full-thickness] macular hole.” 

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures. 


Chehaibou I, Hubschman J-P, Kasi S, et al. Spontaneous conversion of lamellar macular holes to full-thickness macular holes: Clinical features and surgical outcomes. Published online January 4, 2021. Ophthalmol Retina. doi: 10.1016/j.oret.2020.12.023