This 70YO female presented with 20/200 vision in her right eye from severe vitreomacular traction with a tractional lamellar macular hole (LMH).
OCT scanning shows a highly elevated posterior hyaloid adherent to the underlying fovea, with tractional splitting of the outer plexiform layer (OPL). There is also a faint nasal epiretinal membrane.
Combined cataract surgery, 23-gauge pars plana vitrectomy, membrane peeling, temporal half-moon inverted ILM flap, and fluid-air-C3F8 exchange was performed.
Three months postoperatively, the tractional LMH was closed with 20/100 acuity. There is still some temporal OPL splitting along with disorganization and thinning of the outer macular layers.
Learning Points:
LMH can be defined as tractional or degenerative (see Govetto et al, AJO 2016;164:99-109). Tractional LMH shows OPL splitting, an intact ellipsoid zone, and is associated with vitreomacular traction and tractional epiretinal membranes.
OCT features of a degenerative LMH include loss of outer retinal tissue below the OPL and an outer retinal ‘bump’. Non-tractional epimacular proliferation is often present and will often extend around the posterior edge of the degenerative LMH.
