Multimodal Imaging of Lamellar Macular Holes

Evolution of imaging techniques has renewed interest in the diagnosis of lamellar macular hole (LMH) and greatly implemented the possibilities of gaining more detailed insights into its pathogenesis. Among noninvasive techniques, optical coherence tomography (OCT) is considered the primary examinati...

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Main Authors: Roberto dell’Omo, Mariaelena Filippelli, Serena De Turris, Andrea Govetto, Pasquale Napolitano, Ermanno dell’Omo, Ciro Costagliola
Format: Article
Language:English
Published: Wiley 2021-01-01
Series:Journal of Ophthalmology
Online Access:http://dx.doi.org/10.1155/2021/8820444
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author Roberto dell’Omo
Mariaelena Filippelli
Serena De Turris
Andrea Govetto
Pasquale Napolitano
Ermanno dell’Omo
Ciro Costagliola
author_facet Roberto dell’Omo
Mariaelena Filippelli
Serena De Turris
Andrea Govetto
Pasquale Napolitano
Ermanno dell’Omo
Ciro Costagliola
author_sort Roberto dell’Omo
collection DOAJ
description Evolution of imaging techniques has renewed interest in the diagnosis of lamellar macular hole (LMH) and greatly implemented the possibilities of gaining more detailed insights into its pathogenesis. Among noninvasive techniques, optical coherence tomography (OCT) is considered the primary examination modality to study LMHs, given its ability to image foveal structure and its widespread availability. OCT also allows to resolve the epiretinal materials associated with LMH, i.e., tractional epiretinal membranes (ERMs) and epiretinal proliferation (EP). En face OCT reconstructions are useful to confirm the foveal abnormalities shown by the eyes with LMH, whereas OCT angiography may reveal alterations of the size and shape of the foveal avascular zone and alterations of the density of the superficial and deep vascular plexuses. On slit-lamp biomicroscopy or fundus camera examination, LMH appears as a round or oval, reddish lesion at the center of the macula, slightly darker than the surrounding retina. The associated tractional ERM, causing wrinkling and glistening of the retinal surface, is usually readily appreciable, whereas EP is hardly apparent on biomicroscopy or fundus photography since the retina surface appears smooth. When imaged with blue fundus autofluorescence (B-FAF) imaging, LMHs are characterized by an increased autofluorescent signal, the intensity of which does not correlate with the thickness of the residual outer retinal tissue. Green reflectance and blue reflectance (BR) images clearly show the increased reflection and wrinkling of the retinal surface caused by tractional ERM associated with LMH. BR and multicolor imaging enable the visualization of EP associated with LMH in the form of a sharply demarcated dark area and in the form of a yellowish area surrounding the hole, respectively. Scarce data regarding invasive imaging techniques, such as fluorescein angiography, for the study of LMH are available in the literature. The aim of this review is to evaluate the contribution that each imaging modality can provide to study the morphologic characteristics of LMH.
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spelling doaj-art-4a91b33ae75c4e3581a92df75caa65ec2025-08-20T03:20:16ZengWileyJournal of Ophthalmology2090-004X2090-00582021-01-01202110.1155/2021/88204448820444Multimodal Imaging of Lamellar Macular HolesRoberto dell’Omo0Mariaelena Filippelli1Serena De Turris2Andrea Govetto3Pasquale Napolitano4Ermanno dell’Omo5Ciro Costagliola6Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, ItalyDepartment of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, ItalyEye Clinic, Polytechnic University of Marche, Via Conca 71, Ancona 60121, ItalyVitreoretinal Division, Bristol Eye Hospital, Lower Maudlin St., BS1 2LX, Bristol, UKDepartment of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, ItalyEye Clinic, Casa di Cura “Villa Maria”, Viale Principe di Piemonte 4, Campobasso 86100, ItalyDepartment of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, ItalyEvolution of imaging techniques has renewed interest in the diagnosis of lamellar macular hole (LMH) and greatly implemented the possibilities of gaining more detailed insights into its pathogenesis. Among noninvasive techniques, optical coherence tomography (OCT) is considered the primary examination modality to study LMHs, given its ability to image foveal structure and its widespread availability. OCT also allows to resolve the epiretinal materials associated with LMH, i.e., tractional epiretinal membranes (ERMs) and epiretinal proliferation (EP). En face OCT reconstructions are useful to confirm the foveal abnormalities shown by the eyes with LMH, whereas OCT angiography may reveal alterations of the size and shape of the foveal avascular zone and alterations of the density of the superficial and deep vascular plexuses. On slit-lamp biomicroscopy or fundus camera examination, LMH appears as a round or oval, reddish lesion at the center of the macula, slightly darker than the surrounding retina. The associated tractional ERM, causing wrinkling and glistening of the retinal surface, is usually readily appreciable, whereas EP is hardly apparent on biomicroscopy or fundus photography since the retina surface appears smooth. When imaged with blue fundus autofluorescence (B-FAF) imaging, LMHs are characterized by an increased autofluorescent signal, the intensity of which does not correlate with the thickness of the residual outer retinal tissue. Green reflectance and blue reflectance (BR) images clearly show the increased reflection and wrinkling of the retinal surface caused by tractional ERM associated with LMH. BR and multicolor imaging enable the visualization of EP associated with LMH in the form of a sharply demarcated dark area and in the form of a yellowish area surrounding the hole, respectively. Scarce data regarding invasive imaging techniques, such as fluorescein angiography, for the study of LMH are available in the literature. The aim of this review is to evaluate the contribution that each imaging modality can provide to study the morphologic characteristics of LMH.http://dx.doi.org/10.1155/2021/8820444
spellingShingle Roberto dell’Omo
Mariaelena Filippelli
Serena De Turris
Andrea Govetto
Pasquale Napolitano
Ermanno dell’Omo
Ciro Costagliola
Multimodal Imaging of Lamellar Macular Holes
Journal of Ophthalmology
title Multimodal Imaging of Lamellar Macular Holes
title_full Multimodal Imaging of Lamellar Macular Holes
title_fullStr Multimodal Imaging of Lamellar Macular Holes
title_full_unstemmed Multimodal Imaging of Lamellar Macular Holes
title_short Multimodal Imaging of Lamellar Macular Holes
title_sort multimodal imaging of lamellar macular holes
url http://dx.doi.org/10.1155/2021/8820444
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AT andreagovetto multimodalimagingoflamellarmacularholes
AT pasqualenapolitano multimodalimagingoflamellarmacularholes
AT ermannodellomo multimodalimagingoflamellarmacularholes
AT cirocostagliola multimodalimagingoflamellarmacularholes