Epiretinal Proliferation Seen in Association With Lamellar Macular Holes

Abstract

Spectral domain optical coherence tomography imaging showed that a subset of patients with LMH had an epiretinal proliferation with medium reflectivity and no evidence of contractile properties that was contiguous with layers of the mid-retina. This phenotype differs from conventionally described ERMs in appearance and induced changes of the underlying retina. Given these distinct anatomical relationships, the presence of LHEP could affect surgical outcomes.

Role of Lamellar Hole–Associated Epiretinal Proliferation in Lamellar Macular Holes

“…Thus, peeling of LHEP might be not as important for relieving epiretinal traction as peeling a standard ERM, but it would have the function of allowing surgical access to the ILM. The role of ILM as epiretinal material exerting traction in association with LMHs seems to be also confirmed by the fact that, as reported by previous studies, 5,12 and as observed in this series, full-thickness macular holes evolved from LMHs and associated with LHEP generally close after surgical removal of ILM.…”

“…5 To be included in the study, the eyes must also present an area of increased autofluorescent signal that colocalized with the inner defect observed in the fovea and was not attributable to an intraretinal cyst based on OCT images.…”

“…Independently from the presence of LHEP, most of the eyes with LMHs tend to remain stable during years-long follow-up, Recently, the enhanced resolution of SDOCT has enabled the recognition of 2 types of epiretinal material that can be detected in association with LMHs: (1) standard ERM, which is a hyperreflective line that is usually accompanied by wrinkling of the underlying retinal surface, and (2) LHEP, which is a thick homogenous layer of material with medium reflectivity that conforms to the retinal anatomy. 1,5,[7][8][9][10] The concomitant presence of a standard ERM and LHEP in association with LMHs has been reported variably in the literature, with values ranging from 10.78% to 46%. 7,9,11 We found this association in 35.7% of the examined eyes.…”

“…[1][2][3][4] The associated epiretinal material can be thin and highly reflective (the so-called standard epiretinal membrane [ERM]) or of medium reflectivity with focal variations in thickness (the so-called lamellar hole-associated epiretinal proliferation [LHEP]). [5][6][7][8][9] Histopathologic analysis has shown that myofibroblasts dominate in highly reflective membranes, whereas membranes of medium reflectivity consist primarily of fibroblasts and hyalocytes. 10,11 As a consequence, it has been hypothesized that membranes of medium reflectivity should possess weaker contractive properties than standard ERMs.…”

The design and validation of an optical coherence tomography-based classification system for focal vitreomacular traction

“…24,25 We did not observe any cases of VMT associated with the recently described entity of lamellar hole-associated epiretinal proliferation. 26 Although the shape of the fovea is currently not known to be a prognostic factor, it is important in distinguishing VMT from VMA and correlates with the width of adhesion and elevation to suggest the extent of traction. In this study, we subclassified shape into normal, loss of inner retinal profile, or eversion of fovea.…”