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    Distinction between lamellar holes and macular pseudoholes

    Continuity of the external limiting membrane (ELM)/ellipsoid layers can help to identify eyes with lamellar macular holes that are likely to benefit from surgery, according to John T. Thompson MD.

    Dr. Thompson of Retina Specialists, Baltimore, MD, addressed two types of partial thickness macular holes—lamellar macular holes and pseudomacular holes (also called pseudoholes). It can be hard to tell them apart, he pointed out.

    The patient at the top fits the definition of a lamellar macular hole; while the patient at the bottom has biomicroscopic evidence of a pseudomacular hole. The central macular thicknesses are virtually identical (213 microns versus 208 microns). So, are they fundamentally different disease entities? (Images courtesy of John T. Thompson MD)

    “You can have two patients with similar central macular thickness,” Dr. Thompson said. “One may fit the definition of a lamellar macular hole and the other a pseudomacular hole.”

    Dr. Thompson defined pseudomacular holes as a clinical diagnosis as seen via slit lamp biomicroscopy versus optical coherence tomography (OCT). “Use pseudomacular holes only to describe the biomicroscopic appearance,” he added.

    In contrast, a lamellar macular hole is defined by the appearance of the fovea via OCT.

    “I’d propose that there is often a steep irregular contour,” Dr. Thompson outlined. “It may have interretinal splitting. Epiretinal membranes are virtually always present, and some eyes have lamellar hole-associated epiretinal proliferation. The natural history of lamellar macular holes is reasonably good, and they don’t tend to progress.”



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