Vitrectomy Improves VA in Patients with Lamellar Macular Holes with Epiretinal Proliferation

Observed gains in visual acuity and the anatomical improvements achieved in patients with lamellar macular holes with epiretinal proliferation treated with the appropriate surgical technique support the consideration of vitrectomy in such cases rather than the adoption of a strategy of observation alone. Photo: Kang NH, et al. J Korean Ophthalm Soc. Click image to enlarge. Lamellar macular hole associated with epiretinal membrane (ERM) proliferation is becoming more recognized in clinical practice, yet uncertainty persists regarding the visual benefits and risk of progression to full-thickness macular hole (FTMH) in surgical vs. observational management. A new systematic review and meta-analysis evaluated visual and anatomical outcomes of the two approaches and found that vitrectomy is associated with clinically meaningful visual acuity improvement without a clear increase in progression to FTMH. The findings were reported in American Journal of Ophthalmology.Researchers analyzed 17 studies encompassing 610 eyes of adult patients with lamellar macular holes and ERM managed with either vitrectomy or observation. The primary outcome was the change in best-corrected visual acuity (BCVA) and the secondary outcome was the rate of progression to FTMH. In surgically treated eyes (14 studies; 328 eyes), vitrectomy was associated with significant visual improvement (pooled mean difference in BCVA -0.170 logMAR.) In contrast, the observational cohort showed no significant change in visual acuity. The pooled rate of progression to FTMH was 7.5% after vitrectomy and 4.2% for the observational group. However, bias-adjusted analyses suggested observation may be associated with a higher rate of progression (up to 27.2%) compared to vitrectomy (up to 20.1%).In their paper, the researchers noted that findings should be interpreted with caution due to the retrospective nature of most included studies and differences in baseline characteristics between the cohorts, as there is a predominance of retrospective case series among the included studies, with only one randomized trial available. “In clinical practice, patients who are selected for vitrectomy are typically those with more pronounced symptoms, worse baseline visual acuity or documented anatomical progression on OCT,” they wrote. “Consequently, these patients may exhibit a comparatively greater potential for postoperative improvement, a factor which can inflate the apparent treatment effect observed in the context of pooled surgical outcomes.”An important point for discussion, and one that warrants further investigation, according to the authors, is the variety of surgical techniques described for the management of patients with lamellar macular hole associated with ERM.Baseline characteristics—including the integrity of the ellipsoid zone, the extent of epiretinal proliferation and initial retinal thickness—appear to function as key predictors of postoperative outcomes and should be meticulously evaluated during case selection, the report stated. Notably, mean baseline visual acuity of the included patients was below 0.39 logMAR in both groups, suggesting that visual acuity was already compromised in a significant proportion of the patients. “From a clinical standpoint, this data supports an individualized management approach,” the authors wrote in their paper. “Observation appears appropriate for patients with mild or no symptoms, stable visual acuity and no evidence of progressive morphological changes on OCT.”In contrast, they continued in their paper, vitrectomy should be considered by experienced vitreoretinal surgeons in symptomatic patients with documented visual decline, ellipsoid zone disruption or progressive lamellar defect enlargement, as surgery is associated with meaningful visual improvement without a clearly increased risk of progression to FTMH. “Shared decision-making remains essential, with careful counseling regarding expected functional benefits, procedural risks and the need for postoperative monitoring.”Future research should focus on determining the most suitable candidates and timing for surgery rather than debating whether surgery should be performed at all, the authors concluded in their paper.Click here for the journal source. Expedito Sabage L, Cunha Miranda JV, Ferreira do Amaral Antunes AB, et al. Vitrectomy versus observation for lamellar macular holes with epiretinal proliferation: a systematic review and meta-analysis. Amer J Ophthalmol. May 24, 2026. [Epub ahead of print.]  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.