Fluorescein Angiography Findings in Eyes With Lamellar Macular Hole and Epiretinal Membrane Foveoschisis

Abstract

The purpose of this paper was to study fluorescein angiography (FA) findings in eyes with lamellar macular hole (LMH), and epiretinal membrane (ERM) foveoschisis. METHODS.In this prospective, observational case series, 46 eyes of patients affected by either LMH or ERM foveoschisis were examined using optical coherence tomography (OCT) and FA. All patients underwent a comprehensive ophthalmological examination and a general workup to exclude uveitis. Main outcome measures were: presence of FA abnormalities, measurements of the areas of vascular leakage, and intensity of pixels in the vitreous. RESULTS. Twenty-four (52.2%) eyes with LMH and 22 (47.8%) with ERM foveoschisis were studied. Overall, FA abnormalities were found in 20 (83.3%) eyes with LMH and 18 (81.8%) with ERM foveoschisis. The median areas of posterior pole and peripheral leakage were 7.52 vs. 1.07 mm 2 (P = 0.03) and 21.8 vs. 3.74 mm 2 (P = 0.02) in the LMH and ERM foveoschisis group, respectively. Disk hyperfluorescence was found in 8 and 4 eyes and perivascular leak in 10 and 4 eyes with LMH and ERM foveoschisis, respectively. OCT-derived measurements of vitreous intensity did not differ between the two groups, and the investigational workup for uveitis was negative in all patients. CONCLUSIONS. Discrete areas of central and peripheral leakage are commonly found in eyes with LMH and ERM foveoschisis, whereas perivascular leak and hyperfluorescence of the disc are less frequently observed. These findings suggest that breakdown of the retinal blood barrier, involving the posterior pole and the periphery, is frequently associated with these two vitreoretinal disorders.

Outcomes of Pars Plana Vitrectomy With Membrane Peel for Lamellar Macular Holes and Related Conditions Using a New Optical Coherence Tomography Consensus Definition

“…16 Other imaging modalities, such as fluorescein angiography, have been used to compare ERMF with LMH but did not show specific differences that would assist in the diagnosis or selection of surgical patients. 17 The percentage of patients with ERMF noted to have foveoschisis on OCT is small. Although these patients have visual outcomes similar to those of patients with ERMF without foveoschisis, the reported rate of macular edema is higher; however postoperatively, residual foveoschisis may be difficult to distinguish from CME.…”

“…16 Other imaging modalities, such as fluorescein angiography, have been used to compare ERMF with LMH but did not show specific differences that would assist in the diagnosis or selection of surgical patients. 17…”

Macular Microvascular Modifications in Progressive Lamellar Macular Holes

“…Consistently with our hypothesis, Yeo et al [ 12 ] recently highlighted angiographic differences between LMHs and ERM foveoschisis, reporting a larger CFZ and a lower parafoveal VD in both SCP and DCP in the former and demonstrating a correlation between BCVA and foveal and parafoveal VD in LMHs which was not present in ERM foveoschisis. Recently, Dell’Omo et al also highlighted how discrete areas of central and peripheral leakage are commonly found in eyes with LMH in fluorescein angiograms [ 19 ]. Our paper detected significant microvascular differences between anatomically progressing and stable LMHs and, most importantly, identified tissue loss as a significant functional prognostic factor in the natural history of the disease.…”

Focal choroidal excavation with foveoschisis

“…Studies have shown that in the setting of ERM, intraretinal cystoid spaces may form. 9,10 The mechanism of schisis, therefore, may be similar to that seen more profoundly in myopic traction maculopathy (MTM), where widespread macular retinoschisis can form in the presence combined biomechanical stresses from inner retinal rigidity, such as vitreomacular traction and ERM, and posterior staphyloma. Just as in MTM, the schisis in the right eye of our patient was located in the outer retina.…”