Association of Epiretinal Membrane with Development of Lamellar Hole

Abstract

Purpose : Lamellar hole (LMH) is believed to be caused by an abortive process in full-thickness macular hole formation (FTMH), which has not been confirmed. Epiretinal membrane (ERM) can be noted in eyes with LMH. We aimed to validate the pathogenic hypothesis of LMH by evaluating ERM and associated retinal findings in eyes with LMH. We also explored the role of ERM in pathogenesis of LMH.

Methods : LMH was defined as irregular foveal contour, break in the inner fovea, and intraretinal split with intact foveal photoreceptors on optical coherence tomography (OCT). Thirty-nine eyes with LMH were prospectively included for this study and imaged by color fundus photography, confocal scanning laser ophthalmoscopy (cSLO; Nidek, Japan), and spectral-domain OCT (3D-OCT, Topcon, Japan). The presence and grade (according to a clinical grading system proposed by Gass) of the ERM were evaluated in eyes with LMH. Associated inner retinal fold was assessed and its topographic relationship with intraretinal split on en face SD-OCT images was analyzed with Image J software.

Results : ERM was identified in all eyes with LMH. In contrast, it was noted only in 2 of 23 eyes (8.7%) with FTMH. The difference in ERM prevalence was statistically significant between the LMH and FTMH. (P < 0.001) In the eyes with LMH, severe form of ERM (Grade 1 or 2) was mostly (69.2%) observed in eyes with LMH. In the eyes with asymmetric intraretinal split, the distribution of ERM was also asymmetric and the retinal area with more severe ERM showed more severe intraretinal splitting. Furthremore, intraretinal split in eyes with LMH showed topographical relationship with associated inner retinal fold. In the LMH patients with follow-up > 2 years, the progression of ERM showed good agreement with LMH progression.

Conclusions : This study suggests that LMH is strongly associated with ERM and ERM-associated retinal change, inner retinal fold. Tractional force associated with ERM may play a significant role in pathogenesis of LMH, which is in contrast to FTMH.