The role of LHEP in spontaneous closure of full-thickness macular holes

Summary

Spontaneous closure of FTMH more common with lamellar-hole associated epiretinal proliferation (LHEP). Retrospective, 20 eyes.

Abstract

Purpose: Spontaneous closure of full-thickness macular holes (SCMH) is a rare condition. However, this can sometimes be seen in patients waiting for operation. Here we present our morphologic findings in SCMH and discuss the possible pathogenesis.

Methods: Retrospective analysis. Over the period of 2014 to 2024, 20 eyes of 20 patients showed SCMH. Morphologic characteristics were evaluated by SD-OCT imaging and patients were categorized by the existence of vitreomacular traction (VMT), epiretinal membrane (ERM) and lamellar hole associated epiretinal proliferation (LHEP). A relevant amount of epiretinal material of medium and homogenous reflectivity was labeled as LHEP. The study population consisted of 13 women and 7 men, all between ages of 52 and 85 years.

Conclusions and importance: LHEP was identified in 12 of the 20 eyes (60%) with spontaneous hole closure. In 4 out of 20 eyes (20%) vitreomacular traction was found, 1 eye (5%) showed epiretinal membrane and another 3 (15%) no epiretinal pathologies at all. The frequent presence of LHEP in eyes with SCMH is in line with the recent postulations that LHEP might be the body’s attempt to counter the tangential traction on the retinal tissue around the hole and thus facilitate its closure. This understanding of the LHEP as a reparative process leads to the discussion whether a more conservative approach towards small full-thickness macular holes in association with LHEP may be justified.