title: En face spectral domain optical coherence tomography analysis of lamellar macular holes.
abstract: OBJECTIVE
  To analyze the anatomical characteristics of lamellar macular holes using cross-sectional and en face spectral domain optical coherence tomography.
  
  
  METHODS
  Forty-two lamellar macular holes were retrospectively identified for analysis. The location, cross-sectional length, and area of lamellar holes were measured using B-scans and en face imaging. The presence of photoreceptor inner segment/outer segment disruption and the presence or absence of epiretinal membrane formation were recorded.
  
  
  RESULTS
  Forty-two lamellar macular holes were identified. Intraretinal splitting occurred within the outer plexiform layer in 97.6% of eyes. The area of intraretinal splitting in lamellar holes did not correlate with visual acuity. Eyes with inner segment/outer segment disruption had significantly worse mean logMAR visual acuity (0.363 ± 0.169; Snellen = 20/46) than in eyes without inner segment/outer segment disruption (0.203 ± 0.124; Snellen = 20/32) (analysis of variance, P = 0.004). Epiretinal membrane was present in 34 of 42 eyes (81.0%).
  
  
  CONCLUSIONS
  En face imaging allowed for consistent detection and quantification of intraretinal splitting within the outer plexiform layer in patients with lamellar macular holes, supporting the notion that an area of anatomical weakness exists within Henle's fiber layer, presumably at the synaptic connection of these fibers within the outer plexiform layer. However, the en face area of intraretinal splitting did not correlate with visual acuity, disruption of the inner segment/outer segment junction was associated with significantly worse visual acuity in patients with lamellar macular holes.
authors.affiliation: *Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; †Department of Vision Science, School of Optometry, University of California, Berkeley, California; ‡West Coast Retina Medical Group, San Francisco, California; and §Department of Ophthalmology, Stanford University School of Medicine, Stanford, California.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Clamp
authors.forename: Geoff
authors.initials: G
authors.lastname: Wilkes
authors.forename: Laura S
authors.initials: LS
authors.lastname: Leis
authors.forename: H Richard
authors.initials: HR
authors.lastname: McDonald
authors.forename: Robert N
authors.initials: RN
authors.lastname: Johnson
authors.forename: J Michael
authors.initials: JM
authors.lastname: Jumper
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Fu
authors.forename: Emmett T
authors.initials: ET
authors.lastname: Cunningham
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Stewart
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Haug
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Lujan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000473:pathology* / Q000503:physiopathology; D012167:Retinal Perforations / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology