Vitrectomy for treatment of a lamellar hole in a patient with exudative macular degeneration: the role of vitreous traction elimination.

摘要

PURPOSE: Lamellar macular hole (LMH) represents a well-defined clinical entity with variable pathophysiologic mechanisms and a controversial therapeutic approach. The purpose of the present work is to present a patient with an epiretinal membrane (ERM)-associated LMH on the background of exudative age-related macular degeneration (AMD) that was successfully managed with pars plana vitrectomy. METHODS: Interventional case report. RESULTS: A 67-year-old man presented with progressive visual loss OS of 5 months' duration. He was diagnosed with an ERM-associated LMH with coexisting subretinal fluid arising by a neovascular membrane on the background of exudative AMD confirmed with fundus fluorescein angiography. He underwent a 3-port pars plana vitrectomy with ERM-internal limiting membrane peeling and gas tamponade (14% C3F8) for treatment of the LMH and ERM with a view to undergo anti-vascular endothelial growth factor treatment for the exudative AMD. Postoperative optical coherence tomography demonstrated complete closure of the LMH with simultaneous total subretinal fluid absorption that was maintained at the 2-month follow-up period. CONCLUSIONS: To our knowledge, this is the first report whereby pars plana vitrectomy in a patient with an ERM-associated LMH on the background of exudative AMD resulted in improvement of both clinical entities. The latter strengthens the role of vitreous traction elimination in exudative AMD and highlights the need for further research.