title: Vitreo-papillary adhesion as a prognostic factor in pseudo- and lamellar macular holes.
abstract: OBJECTIVE
  To determine the incidence of vitreopapillary adhesion (VPA) and to investigate its value as a prognostic factor in the surgical outcome of pseudo- (PMH) and lamellar macular holes (LMH).
  
  
  METHODS
  A total of 76 consecutive patients, diagnosed with PMH (41 eyes) or LMH (35 eyes) were included. Eyes with VPA were alternatively assigned to the surgical or control group. Surgery consisted of a 25G vitrectomy and internal limiting membrane peeling with blue dye staining. There were six visits: baseline, the day of surgery, and 1, 3, 6, and 9 post-operative months. Main outcome measures were the incidence of VPA and changes in the outer retinal layers and visual acuity.
  
  
  RESULTS
  VPA was found in 27% (11/41) of patients with PMH and 37% (13/35) with LMH (P=0.03). In presence of VPA, the best-corrected visual acuity (BCVA) improved in the surgery group from 32 ± 8 to 47 ± 8 letters, whereas the control group went from 34 ± 7 to 31 ± 8 letters. The difference in letters between the surgery and control groups was statistically significant for both distance (P=0.032) and near (P=0.04) vision. Intra-retinal cysts were significantly correlated with a poor functional prognosis (P=0.01). We found the presence of focal damage to the outer retinal layers in LMH and PMH.
  
  
  CONCLUSIONS
  VPA is more frequent in the presence of LMH vsPMH. It significantly influences the tangential forces at the vitreoretinal interface, exacerbating anatomical changes, and worsening the functional prognosis. Functional difference between the surgical and control groups was statistically significant for distant and near vision in presence of VPA.
authors.affiliation: Department of Ophthalmology, Istituto Clinico Humanitas, Rozzano, Italy. romanomario@email.it
authors.forename: M R
authors.initials: MR
authors.lastname: Romano
authors.forename: J L
authors.initials: JL
authors.lastname: Vallejo-Garcia
authors.forename: F I
authors.initials: FI
authors.lastname: Camesasca
authors.forename: P
authors.initials: P
authors.lastname: Vinciguerra
authors.forename: C
authors.initials: C
authors.lastname: Costagliola
mesh_terms: D001485:Basement Membrane / Q000601:surgery; D019773:Epiretinal Membrane / Q000601:surgery; D005128:Eye Diseases / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D012167:Retinal Perforations / Q000150:complications* / Q000601:surgery; D000267:Tissue Adhesions; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D014822:Vitreous Body / Q000473:pathology*