Abstract
Purpose :
The international classification of lamellar macular hole (LMH) and macular pseudohole (MPH) was proposed in 2013 (Ophthalmology, 2013). However, with the advances in optical coherence tomography (OCT), it has been pointed out that there are cases where it is difficult to distinguish between LMH and MPH with the classification and there is still debate over the definition of these diseases. To clarify these issues, we retrospectively assessed both LMH and MPH using a combination of en face and radial B-scan images and compare the results with the conventional classifications.
Methods :
En face and radial B-scan OCT images of 63 eyes of 60 patients diagnosed with LMH or MPH based on an international classification were reviewed. Cases were classified using en face images based on the presence/absence of epiretinal membrane (ERM), retinal folds, parafoveal epicenter of contractile ERM (PEC-ERM), and retinal cleavage. We compared the en face imaging-based classification system with the international classification system using radial B-scan images. We quantitatively evaluated visual function and macular morphology. Main outcome measure was characterization of multimodal OCT-based subtypes of LMH and MPH.
Results :
All cases showed ERM and were classified into 4 groups. In the first group, which lacked retinal folds and showed significantly lower visual acuity than the other groups (p<0.001, one-way ANOVA), 81% of eyes had degenerative LMH. In the second group, which lacked PEC-ERM and retinal cleavage and showed significantly lower retinal fold depth (p=0.012, one-way ANOVA), all eyes had MPH. The third group, in which 95% of eyes had symmetric tractional LMH, included eyes with retinal cleavage but without PEC-ERM, and this group showed higher circularity of the foveal aperture and cleavage area than the group with both these features (p<0.001, one-way ANOVA, p=0.03, unpaired t test, respectively), in which all eyes had asymmetric tractional LMH.
Conclusions :
Multimodal OCT enables classification of LMH and MPH based on pathological conditions. Retinal traction in particular is key to difference in morphology of LMH and MPH.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.