LHEP embedding has an edge over ILM peeling alone for lamellar macular holes


Examination of patient outcomes of PPV with lamellar hole–associated epiretinal proliferation (LHEP) embedding and conventional internal limiting membrane (ILM) peeling vs. PPV with ILM peeling only revealed better acuity and anatomic outcomes with the LHEP embedding technique for lamellar macular holes (LMHs).

Study design

This was a single-center retrospective study of 39 patients (40 eyes) with LMHs and LHEP. The study included 23 eyes that underwent PPV with LHEP embedding technique and ILM peeling (group E) and 17 eyes that underwent PPV with ILM peeling only (group I).


The postoperative BCVA was significantly better in Group E at the 3-month follow-up (P = 0.001) and the final visit (P < 0.001), but there was no significant visual improvement at 3 months (P = 0.565) or the final visit (P = 0.649) in group I. Patients in group I had lower visual acuity at the final visit than in the preoperative period. There was no statistical difference in the post-operative vision or vision improvement between the 2 groups. There was significantly lower post-operative macular hole formation in group E (0/23) compared to group I (5/17, p = 0.005).


The sample size is small, and it is a retrospective study.

Clinical significance

The embedding technique appears to have a trend toward better visual outcomes in patients with LHEP and a lower incidence of post-operative full thickness macular holes.  

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