Development and Progression of a Lamellar Macular Hole With Lamellar Hole–associated Epiretinal Proliferation

Abstract

Purpose: To describe evolution and progression of a lamellar macular hole (LMH) with “lamellar hole–associated epiretinal proliferation (LHEP)” using spectral-domain optical coherence tomography and fundus autofluorescence. Methods: Observational case report. Results: We report on a 63-year-old male patient demonstrating a complete history of LMH development with LHEP occurring during a follow-up period of 8 years. Presenting with a normal foveal contour and attached posterior vitreous at first visit, an LMH developed shortly after incomplete posterior vitreous detachment with vitreopapillary adhesion. On spectral-domain optical coherence tomography images, progression of the LMH including enlargement of the intraretinal cavitation and decrease in the retinal thickness were documented. An increase of LHEP was first documented 6 months after LMH evolution. One month after cataract surgery and 6 years after the first visit, a full-thickness macular hole developed that closed spontaneously after 4 weeks. Localization of LHEP had moved into the foveal defect toward the outer retinal layers. Thereafter, the LMH was stable, and the patient presented with a visual acuity of 20/25. Conclusion: Proper follow-up time is important for studying eyes with an LMH. Epimacular cell proliferation shows progression over time that appears to be associated with morphologic changes of the LMH including shape of the lamellar defect, amount of LHEP, and contractive properties of epiretinal tissue. The presence of LHEP was documented shortly after posterior vitreous detachment.

Full-Thickness Macular Hole Progressing from Lamellar Macular Hole with Epiretinal Proliferation

“…LMHs are invariably accompanied by ERM and/or epiretinal proliferation and can occasionally progress to FTMH [6,7,9,[11][12][13][14][15]. The pathogenesis of LMH progression to FTMH is poorly understood, but it is evident that the vitreous plays no role.…”

Lamellar hole-associated epiretinal proliferation presenting with perifoveal exudative vascular anomalous complex

“…Interestingly, long-term follow-up of LHEP has found not only that the size of LHEP increases on average, but that LHEP can also migrate from the retinal surface into the macular hole towards the outer retinal layers 17 . Therefore, the first possible etiologic scenario in the patient described here might be the coincident presence of a lamellar hole with associated epiretinal proliferation and PEVAC, which gained connection to LHEP tissue because of long-standing disease and LHEP migration towards the vascular lesion.…”

Lamellar macular holes: evolving concepts and propensity for progression to full thickness macular hole

“…In LMHs epiretinal proliferation is seen around/surrounding the edges of the defect and moulds with the inner retinal anatomy [7]. Both ERM and epiretinal proliferation can co-exist manifesting mixed features [4,7,9,10,12].…”

“…During the mean follow-up period of 26 months only one eye progressed to FTMH but it is not specified from which group; otherwise functionally & morphologically the LHEP group fared worse. Compera et al [ 12 ] reported a case of LMH with LHEP (epiretinal proliferation) that progressed to FTMH. dell’Omo et al [ 9 ] analysed 84 eyes with LMH, of which 43 had standard ERM alone (likely similar to ERM foveoschisis), 11 had LHEP alone (likely similar to true LMH) and 30 had both.…”

“…LMHs are invariably accompanied by ERM and/or epiretinal proliferation and can occasionally progress to FTMH [ 6 , 7 , 9 , 11 , 12 , 15 – 18 ]. The pathogenesis of LMH progression to FTMH is poorly understood but it is evident that the vitreous plays no role.…”