Full-Thickness Macular Hole Progressing from Lamellar Macular Hole with Epiretinal Proliferation

Abstract

Foveoschisis in association with contractile epiretinal membrane is frequently misdiagnosed as lamellar macular hole (LMH). The progression of true LMH with associated epiretinal proliferation to full-thickness macular hole (FTMH) is probably underestimated. We report a case of bilateral FTMH progressing from LMH with epiretinal proliferation. A 72-year-old male presented with increased blurring of vision in left eye. Visual acuity was 20/40 in right and 20/50 in left eye. Examination showed FTMH with epiretinal proliferation in left eye and LMH with epiretinal proliferation in right eye. Surgery of the left eye achieved successful closure of macular hole with improvement in vision. He presented again a month later with further deterioration of vision in right eye. Examination revealed FTMH in right eye with epiretinal proliferation. Surgery of the right eye also achieved optimum functional and morphological results. This case demonstrates that LMH with epiretinal proliferation may have a propensity to progress to FTMH.

Keywords: Epiretinal proliferation; Full-thickness macular hole; Lamellar macular hole.

Fig. 1

OCT images of the left eye. a On presentation, a FTMH with epiretinal proliferation at its edges seen as a homogeneous, isoreflective layer covered by a thin hyper-reflective line contiguous with inner retina (arrows). b At one-month post-surgery, the macular hole is closed; a small ORD is seen. c At 2-month post-surgery, the ORD has resolved. FTMH, full-thickness macular hole; OCT, optical coherence tomography; ORD, outer retinal defect.

Fig. 2

OCT images of the right eye. a, b On presentation, shows a typical LMH with irregular foveal contour with thinning, foveal cavity, epiretinal proliferation, and disruption of ellipsoidal layer and external limiting membrane. Epiretinal proliferation is seen as a thick homogeneous, isoreflective layer covered by a thin hyper-reflective line at the edges of the hole contiguous with inner retina (arrows). The detached posterior hyaloid is also seen. c On occurrence of FTMH, epiretinal proliferation at the hole edges (arrows) appears contiguous with the inner retina (arrows). d At one-month post-surgery, the macular hole is closed; an ORD is seen. LMH, lamellar macular hole; FTMH, full-thickness macular hole; OCT, optical coherence tomography; ORD, outer retinal defect.