title: Lamellar Macular Hole: Two Distinct Clinical Entities?
abstract: OBJECTIVE
  To investigate whether lamellar macular holes can be divided into different subgroups.
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  In this institutional study, clinical charts and spectral-domain optical coherence tomography (OCT) images of 102 eyes of 90 consecutive patients diagnosed with lamellar macular hole were reviewed. In OCT imaging, the presence of lamellar macular hole was defined according to the following findings: presence of irregular foveal contour, separation of the layers of the neurosensory retina, and the absence of full-thickness macular defect. Mean outcome was the morphologic and functional characterization of different subtypes of macular hole.
  
  
  RESULTS
  Two different subtypes of lamellar macular hole were identified: tractional and degenerative. The first type, tractional, was diagnosed in 43 eyes, and was characterized by the schitic separation of neurosensory retina between outer plexiform and outer nuclear layers. It often presented with an intact ellipsoid layer and was associated with tractional epiretinal membranes and/or vitreomacular traction. The second type, degenerative, was diagnosed in 48 eyes, and its distinctive traits included the presence of intraretinal cavitation that could affect all retinal layers. It was often associated with nontractional epiretinal proliferation and a retinal "bump." Moreover, it often presented with early ellipsoidal zone defect and its pathogenesis, although chronic and progressive, remains poorly understood. Eleven eyes shared common features with both tractional and degenerative lamellar macular holes and were classified as mixed lesions.
  
  
  CONCLUSIONS
  Degenerative and tractional lamellar macular holes may be 2 distinct clinical entities. A revision of the current concept of lamellar macular holes is needed.
authors.affiliation: Retina Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Andrea
authors.initials: A
authors.lastname: Govetto
authors.affiliation: Retina Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Yann
authors.initials: Y
authors.lastname: Dacquay
authors.affiliation: Retina Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Farajzadeh
authors.affiliation: Retina Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Eva
authors.initials: E
authors.lastname: Platner
authors.affiliation: Retina Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Kyle
authors.initials: K
authors.lastname: Hirabayashi
authors.affiliation: Retina Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hosseini
authors.affiliation: Retina Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Schwartz
authors.affiliation: Retina Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. Electronic address: Hubschman@jsei.ucla.edu.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Hubschman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019773:Epiretinal Membrane / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000473:pathology*; D012167:Retinal Perforations / Q000145:classification* / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology