Redefining Lamellar Holes and the Vitreomacular Interface: An Ultrahigh-Resolution Optical Coherence Tomography Study

Abstract

Objectives-To define optical coherence tomographic (OCT) criteria for the diagnosis of a lamellar macular hole, and to increase understanding of lamellar hole pathogenesis by examining fine anatomic features using ultrahigh-resolution optical coherence tomography (UHR OCT).Design-Retrospective observational case series.

Vitreo-papillary adhesion as a prognostic factor in pseudo- and lamellar macular holes

“…Hence, LMH and PMH are currently described as defects of the inner retina with intraretinal cystoid spaces, sometimes associated with epiretinal membrane formation, in the presence of intact outer retinal layers and an undamaged photoreceptor layer. Our findings differ with previous descriptions of PMH and LMH, 7,8 as we have demonstrated the presence of focal damage to the outer retinal layers: the ELM and the IS/OS junction ( Figure 4). The ELM, formed by continuous bands of intermediate junctions that link the photoreceptor nuclei to Mü ller cells, and the connecting cilium (IS/OS junction) between the inner and outer segment of the photoreceptor, are well illustrated by SD-OCT. 9 The integrity of the ELM, rather than the integrity of the IS/OS junction, might better reflect the integrity and function of the whole photoreceptor.…”

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

“…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.…”

“…In line with previous observations, standard ERMs were more common than LHEP, with only 11 of 84 eyes showing no trace of standard ERM. 1,6,7 It must be noted that identifying the presence of trace amounts of LHEP in cases with a prominent, standard ERM and vice versa may be difficult and easily should be avoided because in several cases, 1 type of epiretinal material is predominant but not exclusive. 7,9 The presence of LHEP does influence some morphologic and functional features of LMHs.…”

“…This finding is important in light of the fact that recommendations for surgical repair of eyes with LMHs are controversial, with some authors reporting good surgical outcomes and others documenting worsening of anatomic features and VA after surgery. 1,3,7,10,11,[21][22][23] The limitations of this study include its retrospective nature, the relatively restricted number of patients, and the variable duration of follow-up.…”

“…Based on spectral-domain optical coherence tomography (SDOCT), LMHs are characterized by an irregular foveal contour, intraretinal splitting or cavitation, and intact or disrupted outer retinal layers. [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.…”