This 62YO female presented with 20/80 vision in her left eye from an asymptomatic lamellar macular hole (LMH). Epiretinal proliferation is adherent to the underlying nerve fiber layer. A localized splitting of the outer plexiform layer (OPL) is seen temporally. There is a loss of tissue below the OPL with a central mound of remaining featureless outer retina.
Learning Points:
LMH can be defined as tractional or degenerative (see Govetto et al, AJO 2016;164:99-109).
Our case has all the classic findings of a degenerative LMH, which Govetto et al. described as resembling the brim of a top hat. The epimacular proliferation often extends around the posterior edge of the LMH, but this was not seen in our case.
Although surgery is usually observed, it can close these holes with some visual improvement (see Morescalchi et al, Retina, 2020;40:1087-1093).
