FLUORESCEIN ANGIOGRAPHY IN EYES WITH LAMELLAR MACULAR HOLE:DOES INFLAMMATION PLAY A ROLE?

Abstract

Purpose : there are few data in the literature regarding fluorescein angiography (FA) findings in eyes with lamellar macular hole (LMH). The aim of the study is to explore whether FA examination may add further insights into the pathogenesis of different subtypes of LMH.

Methods : patients with LMH associated with standard epiretinal membrane (ERM) and/or epiretinal proliferation (EP) were included. Exclusion criteria were:history of uveitis,diabetes,retinal vascular diseases,post-operative inflammation,high myopia and previous retinal surgery. All patients underwent a general work-up to exclude uveitis.FA and simultaneous FA/OCT images of the posterior pole and of the periphery(standard ETDRS fields) were recorded till 10 minutes after injection of the dye using the Heidelberg Spectralis system (Heidelberg Engineering,Heidelberg,Germany). Areas of leakage on FA were outlined and measured using ImageJ.

Results : 42 patients with LMH fulfilled criteria to be included into the study. Work-up for uveitis was negative in all patients. OCT examination showed the presence of a standard ERM in all but 2 cases and EP in 22 cases. FA showed leakage in the macular area in 38,peripheral leakage in 30,focal vasculitis in 14 and hyperfluorescence of the disc in 12 cases. Although leakage at the posterior pole was present in18 and 20 eyes with ERM alone and EP respectively, peripheral leakage was observed in 10 eyes with ERM alone and in 20 with EP.The total area of peripheral leakage measured 150.69 and 1033,75 µm² in the eyes with ERM alone and EP,respectively(P= 0.001).Similarly focal vasculitis was noted in 4 and 10 and hyperfluorescence of the disc in 4 and 8 of cases with ERM alone and EP,respectively.

Conclusions : Eyes with EP show a higher rate of peripheral leakage,focal vasculitis and hyperfluorescence of the disc in comparison to eyes with ERM alone.These angiographic features may suggest a role of inflammation in the pathogenesis of the LMH associated with EP.

This is a 2020 ARVO Annual Meeting abstract.

 

LMH associated with ERM:FA pictures show focal areas of leakage at the posterior pole.

 

LMH associated with EP:FA pictures show focal areas of leakage at the posterior pole and in the periphery along with hyperfluorescence of the disc.