Lamellar Macular Hole

Lamellar Macular Hole
SYMPTOMS Typically asymptomatic
Can develop central vision loss and metamorphopsia (in the presence of ellipsoid zone disruption)
SIGNS Absent foveal reflex, Epiretinal membrane, Cystoid macular edema
Tractional lamellar macular hole: Enlarged foveal depression with loss of inner retinal layers. Ellipsoid zone is typically intact. Associated with cystoid macular edema and epiretinal membranes
Degenerative lamellar macular hole: Enlarged foveal depression with loss of inner retinal layers and often ellipsoid zone disruption. Associated with cystoid macular edema, epiretinal proliferation, and splitting of the outer plexiform layer (Schisis)
WORK-UP Full eye exam with dilated retinal exam, OCT analysis of the macula (signs of a lamellar macular hole are best seen with an OCT), Fluorescein Angiography, Fundus Autofluorescence, Fundus photos, Infrared retinal imaging, Watzke-Allen test, Macular photostress test, Amsler grid
TREATMENT Lamellar macular holes typically do not require any treatment. Give take home Amsler grid in order to monitor for change
Criteria for referral to a retinal specialist and surgery: Vision that is less than or equal to 20/60, Vision that is better than 20/60 but patient reports metamorphopsia, Anatomical progression seen on the macular OCT, or Development of a full thickness macular hole
FOLLOW-UP If monitoring, the patient should be seen back every 6-12 months (depends on the size, extent, and stability of the lamellar macular hole)
Once patient is stable following surgery, patient should be seen back every 6-12 months
ADDITIONAL LAB | TESTS None
ETIOLOGY Development occurs due to degenerative changes and/or tractional forces from an epiretinal membrane and/or cystoid macular edema
DIFFERENTIAL DX Full thickness macular hole, Cystoid macular edema, Epiretinal membrane
NOTES A traditional lamellar macular hole and degenerative lamellar macular hole could both develop into a full thickness macular hole
Lamellar Macular Hole: OCT of the macula demonstrating loss of inner retinal layers and ellipsoid zone disruption/loss https://imagebank.asrs.org/file/28529/lamellar-macular-hole

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