Mixed Pathophysiologies of Lamellar Macular Holes and Related Diseases

Abstract

Purpose: To investigate the characteristics of mixed pathophysiologies in lamellar macular holes (LMH) and related diseases using multimodal optical coherence tomography (OCT). Methods: Overall, 126 eyes diagnosed with LMH, epiretinal membrane foveoschisis (ERM-FS), or macular pseudohole (MPH) using the horizontal B-scan image according to the definition proposed by Hubschman et al. in 2020 were analyzed using multimodal OCT imaging including horizontal and vertical 5-line B-scan, radial scan, and macular three-dimensional volume scan images. If at least two diagnostic criteria for LMH, ERM-FS, or MPH were satisfied in these scans, the patient was diagnosed as having a "mixed type.” Retinal traction force was quantitatively evaluated by measuring the maximum depth of the retinal folds (MDRF) using en-face images. Results: Mixed types constituted 34.1% of the cases. The LMH-related mixed group demonstrated intermediate characteristics between the ERM-FS/MPH and true LMH groups in terms of retinal traction and LMH-specific features and had a significant positive correlation between the MDRF and mean M-CHARTS scores (P = 0.034). Conclusion: A thorough OCT analysis is necessary to accurately diagnose LMH and related diseases. A significant positive correlation was observed between the MDRF and the degree of metamorphopsia in the LMH-related mixed group.