Epiretinal Proliferation Embedding Without Internal Limiting Membrane Peeling For Lamellar Macular Hole

Purpose: To report anatomical and functional outcomes of epiretinal proliferation (EP) embedding without internal limiting membrane (ILM) peeling for lamellar macular holes (LMHs) with EP. Methods: This retrospective interventional case series involved patients with idiopathic LMHs and EP who underwent pars plana vitrectomy using the EP-embedding technique without ILM peeling. The EP was peeled centripetally, left connected to the LMH edge, and embedded into the retinal cleavage plane. 20% sulfur hexafluoride gas tamponade was applied. Following surgery, patients were recommended to avoid lying face-up. Results: Fifteen eyes of 15 patients were included, the mean follow-up was 12 ± 8 months. LMH closure was achieved in 100% of cases. Best-corrected visual acuity and central retinal thickness showed significant postoperative improvement, from 0.31 ± 0.20 logMAR (20/40 Snellen) and 156.5 ± 40.7 μm preoperatively to 0.10 ± 0.12 logMAR (20/25 Snellen) (p = 0.002) and 221.5 ± 46.5 μm (p < 0.001), respectively. Ellipsoid zone and external limiting membrane restoration rates were 50% and 100%. No cases of full-thickness macular hole formation, LMH recurrence, or major complications were observed. Conclusions: EP-embedding without ILM peeling yields favorable anatomical and functional outcomes in LMHs with EP and supports the non-tractional pathophysiology of the condition.