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Andrea Govetto, Hamid Hosseini, Steven D. Schwartz, Jean Pierre Hubschman; Insight into lamellar macular holes: two distinct clinical entities.. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate whether lamellar macular holes can be divided into different subgroups.
In this institutional study, clinical charts and Spectral-Domain Optical Coherence Tomography (OCT) images of 112 eyes of 100 consecutive patients diagnosed with lamellar macular hole were reviewed.In OCT imaging, the presence of lamellar macular hole was defined according to the following findings: presence of irregular foveal contour, separation of the layers of the neurosensory retina, and the absence of full thickness macular defect.Mean outcome was the morphological and functional characterization of different subtypes of macular hole.
Two different subtypes of lamellar macular hole were identified: tractional and degenerative. The first type, tractional, had a "moustache" appearance, was diagnosed in 47 eyes (42%), and was characterized by the schisic separation of neurosensory retina between outer plexiform and outer nuclear layers. It often presented with an intact ellipsoid layer (98%, 46/47) and was associated with tractional epiretinal membranes and/or vitreo-macular traction (97%, 45/47). The second type, degenerative, had a "top hat" appearance, was diagnosed in 53 eyes (47%), and its distinctive traits included the presence of intra-retinal cavitation that could affect all retinal layers. It was often associated with non-tractional epiretinal proliferation (98%, 52/53) and a retinal “bump” (87%, 46/53). Moreover, it often presented with early ellipsoidal zone defect (95%, 50/53) and its pathogenesis, although chronic, and progressive remains poorly understood.Twelve eyes (11%) shared common features with both tractional and degenerative lamellar macular holes and were classified as mixed lesions.
Degenerative and tractional lamellar macular holes are two distinct clinical entities. A revision of the current concept of lamellar macular holes is needed.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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