Abstract
Lamellar macular holes (LMHs) may show morphological and functional deterioration over time, yet no definite prognostic factor for progression has been identified. Since neurovascular retinal unit impairment may take part in neurodegeneration, we compare progressive LMHs to stable ones in optical coherence tomography (OCT) angiography parameters. Methods: OCT B scans of eyes with LMH were analyzed to detect the presence of tissue loss (TL) over time, allowing us to identify a TL group and a stable (ST) group (14 patients each). The best corrected visual acuity (BCVA) at each considered imaging time point was collected. Lastly, patients underwent macular OCT angiography. Results: BCVA at last follow up was significantly reduced in the TL group compared to both the ST group and TL group baseline assessment. SCP foveal vessel density (VD), SCP and deep capillary plexus (DCP) perfusion density (PD) and parafoveal PD were lower in the TL group. Linear correlations between quantitative TL over time and parafoveal PD in SCP and between the speed of TL and BCVA variation during follow up were also detected. Conclusions: TL in LMHs is associated with both OCT angiography modifications and BCVA deterioration over time. We suggest these findings to be a manifestation of foveal Muller cell impairment in progressive LMHs.
Highlights
Lamellar macular hole (LMH) is a vitreoretinal interface disorder affecting 1.1 to 3.6% of the general population, mainly within the range of 50–70 years of age [1,2,3]
Foveal and parafoveal perfusion density (PD) were found to be significantly lower in both superficial capillary plexus (SCP) and deep capillary plexus (DCP) in progressive compared to stable LMHs
The amount of tissue loss linearly correlated with total SCP parafoveal PD and the area of tissue loss colocalized with the region of SCP angiograms, showing the lowest parafoveal PD in all
Summary
Lamellar macular hole (LMH) is a vitreoretinal interface disorder affecting 1.1 to 3.6% of the general population, mainly within the range of 50–70 years of age [1,2,3]. The second, which is referred to as “true” LMH, is identified through the presence of irregular foveal contour, foveal cavities with undermined edges and signs of foveal tissue loss. In addition to anatomical characteristics, LMHs are characterized by a more pronounced visual acuity (VA) loss, retinal pigmented epithelium (RPE) damage, and poorer response to surgical treatment compared to ERM foveoschisis [6,7,8]. A proportion of patients with LMHs manifest severe visual impairment and/or show anatomical signs of progressive tissue loss on optical coherence tomography [8,9]. The biggest limit of this classification of LMHs is the inability to predict functional prognosis due to the fact that no morphological parameter has been clearly correlated to the progression of the disease to the present date [10]. The aim of the study is to assess differences in OCTA parameters in progressive degenerative LMHs compared to stable ones
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