Denise Vogt1, Joachim Wachtlin2,3, Siegfried G Priglinger4, Ricarda G Schumann4. 1. Augenklinik der Universität München, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland. denise.vogt@med.uni-muenchen.de. 2. Augenabteilung, Sankt Gertrauden Krankenhaus, Berlin, Deutschland. 3. MHB, Medizinische Hochschule Brandenburg, Neuruppin, Deutschland. 4. Augenklinik der Universität München, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland.
Abstract
BACKGROUND: In recent years the high resolution of optical coherence tomography (SD-OCT) has led to a more exact and detailed imaging of different morphological types of lamellar macular holes (LMH). This resulted in new knowledge on the pathogenesis, morphology and progression of the disease; however, this also resulted in a lack of clarity in the terminology and in particular led to uncertainty in the treatment of these patients in clinical practice. OBJECTIVE: This article gives an overview on the morphological characteristics and treatment indications for LMH with the aim of enabling a clear differentiation compared to other morphological alterations in traction macular pathologies. MATERIAL AND METHODS: The evaluation is based on the current literature and own study data from the Department of Ophthalmology at the University of Munich, Germany. RESULTS: In eyes with LMH different morphological forms can be seen in SD-OCT. In addition to the known diagnostic criteria of irregular foveal contour, intraretinal splitting and defect of the inner foveal layers, the occurrence and characteristics of epiretinal tissue as well as the occurrence of photoreceptor layer defects can be evaluated. CONCLUSION: Further development of imaging techniques, such as SD-OCT led to improved visualization of different types of LMH. Decisions on treatment should be based on subjective complaints, best corrected visual acuity (BCVA), the clinical course, the presence of defects of the ellipsoid zone, occurrence and characteristics of epiretinal tissue. In cases of progression of symptoms and/or traction by the epiretinal tissue, an early surgical procedure has a good prognosis for functional and anatomical rehabilitation.
BACKGROUND: In recent years the high resolution of optical coherence tomography (SD-OCT) has led to a more exact and detailed imaging of different morphological types of lamellar macular holes (LMH). This resulted in new knowledge on the pathogenesis, morphology and progression of the disease; however, this also resulted in a lack of clarity in the terminology and in particular led to uncertainty in the treatment of these patients in clinical practice. OBJECTIVE: This article gives an overview on the morphological characteristics and treatment indications for LMH with the aim of enabling a clear differentiation compared to other morphological alterations in traction macular pathologies. MATERIAL AND METHODS: The evaluation is based on the current literature and own study data from the Department of Ophthalmology at the University of Munich, Germany. RESULTS: In eyes with LMH different morphological forms can be seen in SD-OCT. In addition to the known diagnostic criteria of irregular foveal contour, intraretinal splitting and defect of the inner foveal layers, the occurrence and characteristics of epiretinal tissue as well as the occurrence of photoreceptor layer defects can be evaluated. CONCLUSION: Further development of imaging techniques, such as SD-OCT led to improved visualization of different types of LMH. Decisions on treatment should be based on subjective complaints, best corrected visual acuity (BCVA), the clinical course, the presence of defects of the ellipsoid zone, occurrence and characteristics of epiretinal tissue. In cases of progression of symptoms and/or traction by the epiretinal tissue, an early surgical procedure has a good prognosis for functional and anatomical rehabilitation.
Authors: Andre J Witkin; Tony H Ko; James G Fujimoto; Joel S Schuman; Caroline R Baumal; Adam H Rogers; Elias Reichel; Jay S Duker Journal: Ophthalmology Date: 2006-03 Impact factor: 12.079