Purchase this article with an account.
J. Inoue, F. Berisha, T. Hirose; A Lamellar Macular Hole -Clinical Features. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4105.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To characterize a lamellar macular hole by optical coherence tomography (OCT) and the microscotometry by Scanning Lasar Ophthalmoscope (SLO) findings.
We examined 61 eyes of 59 Patients, 35 female and 24 male, aged 29-94 years (mean 68.5) who were found to have a lamellar macular hole by OCT. Besides complete clinical examination, microperimetry was performed with SLO in 32 eyes.
Median visual acuity was 20/40 (range, 20/15-20/200). The mean follow up period was 25 months (range, 2-44 months). Patients’ symptoms were decreased vision or distortion. 8/58 Patients had no visual symptoms. Lamellar macular hole was suspected in 20 eyes (42%) by clinical examination including the slit lamp biomicroscope. More than half of the patients (58%) were diagnosed by OCT. Two patients showed bilateral lamellar macular hole, and 4 patients with a lamellar macular hole in one eye had full-thickness macular hole in the fellow eye. 6 eyes had high myopia. 47 eyes (77%) showed epiretinal membrane (ERM). SLO microscotometry revealed a relative central scotoma in all patients and a dense central scotoma in one. Lamellar macular holes remained essentially unchanged during the observation period in all patients except one who developed a full-thickness macular hole. Standard cataract surgery with intraocular lens implantation was performed in 7 eyes. Lamellar macular holes remained unchanged after surgery. None of these patients developed full-thickness macular hole after surgery. Vitrectomy was performed in one eye with poor vision (20/200) and a dense central scotoma. This eye had severe preretinal membrane with proliferative diabetic retinopathy having undergone closed vitrectomy and membrane peeling before development of a lamellar macular hole. After the surgery vision improved to 20/80 and scotoma became smaller but persisted.
A lamellar macular hole can be missed particularly in high myopic eye that shows light fundus reflection from atrophic choroid. OCT is essential for its diagnosis. It also helps differential diagnosis from pseudo macula hole. SLO is useful in diagnosis a lamellar macular hole. A lamellar hole stayed unchanged in most patients. A through and through macular hole developed in one case out of 60 eyes. Cataract combined with lamellar macular hole can be managed by cataract operation alone.
This PDF is available to Subscribers Only