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Improve Macular Hole Surgery with Optical Coherence Tomography

Explore a case study about intraoperative OCT-assisted pediatric lamellar macular hole repair

Fundus photo depicting epiretinal membrane with lamellar macular hole. Image courtesy of Robert A. Sisk, MD, FACS, Cincinnati Eye Institute.  Epiretinal-membrane-with-lamellar-macular-hole.jpg

A macular hole is a rare eye condition that blurs central vision and impacts everyday tasks. Macular holes are usually caused by stretching or pulling the macula, causing an opening to occur. Typically, the most common cause of macular holes is age-related changes to the eye. However, in this case study Robert A. Sisk , MD, FACS presents a pediatric ophthalmology case in which intraoperative optical coherence tomography provided him with additional insights during surgery.

Vitrectomy is the most common treatment for vitreoretinal interface diseases, such as epiretinal membranes and macular holes. It has a success rate of over 90%, with the vast majority of patients regaining some or most of their lost vision [1].

In some chronic epiretinal membranes, the tissue thickens into an epiretinal proliferation that displaces foveal tissue, forming a lamellar macular hole. In general, lamellar macular hole repair has guarded visual expectations compared to treatment of epiretinal membranes and macular holes. 

About the case study

Key Learnings

  • Learn about the surgical management of a 9-year-old boy with epiretinal membrane in both eyes
  • Discover the surgical approach to close the lamellar macular hole and the course of the operation
  • Understand the role of intraoperative optical coherence tomography

The inverted internal limiting membrane (ILM) flap technique may increase anatomic and visual outcomes for full thickness or lamellar macular holes. This case demonstrates how intraoperative optical coherence tomography (OCT) provides valuable real-time information and insights during pediatric macular hole repair to avoid dislodging the ILM flap.

Case Description

A 9-year-old boy presented with complaints of blurred and distorted vision in the left eye. He had congenital cystic encephalomalacia that resulted in seizures and multiple falls in his early childhood. There was no recent trauma or family history of seizure disorder, and he was neurologically intact.

On examination, the anterior segment was normal but both eyes had an epiretinal membrane, greater in the left eye, with lamellar macular hole.

There was no hearing loss or family history of neurofibromatosis type 2. The boy was having difficulty playing sports due to reduced depth perception, especially with baseball.

Pre-operative assessment

Visual acuities were subnormal in both eyes, and particularly in the left eye at 20/60. There was an area of chorioretinal scarring temporally in the left eye. This may represent resolution of previous commotio retinae.

Surgical approach

The surgical plan was to remove the epiretinal membrane, elevate the epiretinal proliferation and use an ILM flap to close the lamellar macular hole.

Continue Reading 

Expand your knowledge with Dr. Sisk’s treatment of the lamellar macular hole utilizing intraoperative optical coherence tomography on the Proveo 8 surgical microscope.

Read the case study

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The statements of the healthcare professional included in this case study reflect only their opinions and personal experiences and not those of Leica Microsystems. They also do not necessarily reflect the opinions of any institution with which they are affiliated. Please note that off-label uses of products may be discussed. Please check with regulatory affairs for cleared indications for use in your region.

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