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Date issued: October 2023

Review date: October 2025

Ref: A-464/WS/Ophthalmology/Understanding Lamellar Holes v2

PDF:  Understanding Lamellar Holes final October 2023 v2.pdf[pdf] 204KB

How to contact The Royal Eye Infirmary

Telephone

Switchboard: 01752 202082

Eye Daycase Unit: 0845 439348

What is the macula? 

Lining the inside of your eye is a thin sheet of nerves called the retina. The retina acts like the film in a camera by turning light entering your eye into a picture for your brain. The central part of the retina is called the macula. The macula is the most important part of the retina and is responsible for your best vision.

What is a lamellar hole? 

A lamellar hole is when you develop a partial thickness split at the very centre of the macula. There are broadly speaking two different types of lamellar hole:

1. Tractional Lamellar Hole: where  there is pulling from a membrane on   the surface of the retina.

2. Degenerative Lamellar Hole: where there is apparent loss of tissue within the central retina

What are the symptoms? 

Patients with lamellar holes most commonly experience blurred central vision. They may also notice that things are distorted near the centre of their vision. These changes develop slowly causing a gradual deterioration in the quality of their vision. In some cases the  lamellar holes are not initially noticed by the patient and are only picked up on a routine visit to the optician.

Although the central vision may be reduced, not all your vision will be lost because of a lamellar hole.

What are the main risks of the operation?

• All patients who have not previouslyundergone cataract surgery will develop a cataract more rapidly.

• One in a thousand chance of loss of vision from a severe eye infection.

• One in a thousand chance of loss of vision from severe eye bleeding.

• One in twenty chance of developing a retinal detachment.

How much vision can I expect after a successful operation?  

In one study the average vision improved  from 6/15 to 6/10 as result of surgery.

However, the outcome was significantly poorer in those with Degenerative Lamellar Holes.

What can I expect after the vitrectomy surgery?

Your vision will be very blurred straight  after the operation for over a month.

You will have to carry out something called “posturing” for between 10 to 14 days. Posturing means that you will have to spend all day looking straight  down at the floor. You are only allowed 10 minutes break in each hour. At night you can sleep on your side. Please ask the nurses on the ward for advice on posturing.

There will be a number of eye-drops that    you will have to regularly put into your eyes for about one month.

After two weeks you will notice a dark line across the middle of your vision. It will be   clear above the line and blurred below the line. The line will gradually become more curved, until it becomes a dark circle at the bottom of your vision. This circle will gradually shrink until it finally disappears between four to six weeks after the operation.

Some important points to remember about the gas in your eye

There are three very important things to remember during the six to eight weeks that you have gas in your eye:

1. Do not lie on your back, unless instructed.

2. Do not go flying in an aeroplane.

3. If for any reason you require a general anaesthetic you must let the anaesthetist know that you have gas in your eye.

What is the treatment?

An operation is the only way to attempt to repair a lamellar hole. It is true that the progress of lamellar holes is very slow and therefore you may choose not to have any intervention in the first instance.

The outcome of surgery is thought to be best in Tractional Lamellar Holes and not  so good in Degenerative Lamellar Holes.

The operation can be carried out under local or general anaesthetic and will involve removal of the jelly-like fluid in the  eye, followed by removal of any membranes from the surface of the macula and then injection of a long-acting  gas bubble into the eye.

Though your eye may feel sore after the operation, there should be little or no pain. As long as there are no problems you can go home on the day of surgery.

What happens if the lamellar hole does not close? 

You would be offered the chance to have  further surgery which again would have a  good chance of closing the hole.

Occasionally, despite all efforts, it may not  be possible to successfully close the hole.

Can lamellar holes be prevented?

No obvious preventative action that can be taken.

What if my sight remains poor?

You can be helped to see many of the things you used to by making use of your remaining sight. Low vision services can help. They can help you find the best magnifiers for you, and can give advice and training about the many often simple ways that can make the most of your sight. Ask the eye specialist, optometrist (ophthalmic optician), GP, social worker or local voluntary organisation about low vision services near you. RNIB can also advise on the help that is available.

Acknowledgements:

Based on:

RNIB & RCOphth Booklet Understanding Retinal Detachment 2001

Diagram: 

National Eye Institute 

National Institutes for Health USA

Heritoglou C et al. Lamellar macular hole surgery current concepts, future prospects. Clin Ophthalmol. 2019:13;143-6.