Optical coherence tomography-based consensus definition for lamellar macular hole

Abstract

BackgroundA consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed.MethodsThe panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions.ResultsThe panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle’s fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness.ConclusionsThe use of the proposed definitions may provide uniform language for clinicians and future research.

Prognostic Factor Analysis of Visual Outcome after Vitrectomy for Rhegmatogenous Retinal Detachment

“…This variable did not show any statistically significant impact on the postoperative visual outcome. After evaluation according to the definition of ERM made by Haubschman et al, however, we found true ERM with traction on macula in only 2% of patients [ 33 ].…”

“…ERM was recorded as well as any presence of irregular and hyper-reflective layer over the internal limiting membrane, regardless of whether there were signs of retinal wrinkling or not. These data were evaluated based on the consensus of OCT definition of ERM by Hubschman et al [ 33 ]. At the same postoperative visit, functional outcomes were recorded by determining BCVA.…”

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

“…Their other proposed subtype tractional LMH does not involve any actual tissue loss, the pathomorphologic changes caused by traction and therefore the panel proposed to name it as 'ERM foveoschisis' . Hubschman et al also proposed that thick ERM/dense ERM/atypical epiretinal tissue/LHEP be named 'epiretinal proliferation' [10]. Although the term LHEP is widely used we agree that it is not precise as the material has been found in conditions other than LMHs in full thickness macular holes (FTMH)s and at extrafoveal sites following trauma iatrogenic and accidental [7].…”

“…ERM traction can cause foveoschisis and the appearance of an irregular foveal contour that can be confused with LMH [10]. The pathogenesis of is similar to that of macular pseudoholes where the morphologic changes are cause by tractional forces exerted by the overlying ERM [4].…”

“…Recently Hubschman, Govetto and other members of an international panel of vitreoretinal experts proposed that only lesions with apparent tissue loss should be considered as LMHs and therefore presence of foveal cavity with undermined edges mandatory for its diagnosis along with irregular foveal contour and other signs of foveal tissue loss like thinning and pseudo-operculum [10]. Optional criteria suggested were epiretinal proliferation, ellipsoid line disruption and foveal bump.…”