Lamellar Macular Hole: State of the Art

Abstract

Lamellar macular hole (LMH) is a vitreoretinal disorder characterized by an irregular foveal contour, a break in the inner fovea, dehiscence of the inner foveal retina from the outer retina, and the absence of a full-thickness foveal defect with intact foveal photoreceptors. The pathogenesis is only partially known. The advent of high-resolution optical coherence tomography has allowed distinguishing between two types of epiretinal membrane (ERM) associated with LMH: a conventional ERM (commonly found in macular pucker) and an atypical ERM (known by varied names: dense, epiretinal proliferation, or degenerative). These two types of ERM not only influence LMH morphology but also differ in cell and collagen composition. It remains unclear if these two types are indeed two distinct clinical entities or rather two stages of the same macular disorder. Studies of the natural evolution of LMH have not fully resolved this issue and also offered variable results. Surgical treatment leads to excellent anatomical and functional outcomes, but not without risks. This review provides a critical summary of the available data on LMH including some new insights.

Hyperreflective Stress Lines and Macular Holes

“…A LMH was defined on SD-OCT as an irregular foveal configuration with thinning and a break in the inner fovea in the absence of a full-thickness foveal defect with intact foveal photoreceptors. 12 LMH were differentiated into degenerative lamellar holes versus tractional lamellar holes with foveoschisis as originally defined by Govetto et al 13 Patients were then divided into three cohorts: patients with tracked SD-OCT volume scans preceding FTMH, patients with tracked SD-OCT scans after FTMH repair and PPVT, and patients with SD-OCT scans of LMH.…”

The Management of Lamellar Macular Holes: A Review

“…e prevalence of LMH in the general population ranges from 1.1% to 3.6% [7]. e first case report showed a progression of LMH to FTMH [4].…”

“…Gass has emitted the supposition that it would be caused by the spontaneous dehiscence of the wall of an intraretinal cyst, during the process of posterior vitreous detachment. e presence of an operculum in front of the fovea would confirm this pathogenic theory [7]. ere are several papers describing the advent of LMHs in diseases associated with CME: post cataract surgery [1], diabetic macular edema [8], retinitis pigmentosa [9], and Coats' disease [10].…”

“…ere are several papers describing the advent of LMHs in diseases associated with CME: post cataract surgery [1], diabetic macular edema [8], retinitis pigmentosa [9], and Coats' disease [10]. However, most cases of LMH are considered idiopathic [7] and it seems the pathogenesis of LMH cannot simply be attributed to abortive anteroposterior traction [11]. e theory of a pathogenic mechanism associated with contraction of ERMs has gained a lot of support as OCT became a standard diagnostic technique-many authors have described ERMs in virtually all cases of LMH [5,[12][13][14][15][16].…”

Use of Autologous Platelets for Lamellar Macular Hole Repair

“…Prone posturing can also be difficult in some patients with previous neck or back injury, vertebral fusion surgery, large body habitus, or respiratory issues. Given the real risk of a FTMH, the call for alternative techniques has been advocated for [9].…”