Cystoid foveal oedema in symptomatic inner lamellar macular holes

Inner lamellar macular hole (LMH) was considered a relatively risk-free condition that rarely progresses or worsens. Nowadays, at the optical coherence tomography (OCT) era, increasing evidence seems to position it differently. The aim of the study was to describe morphologic abnormalities associated with symptomatic LMH using OCT that may explain reduced visual acuity in these patients.

In a retrospective study on consecutive symptomatic patients with LMH, OCT scans were compared with normal controls. Analysis was referred to LMH-associated abnormalities at the residual fovea, mainly cystoid spaces that manifested as cystoid foveal oedema.

A total of 22 eyes of 20 patients (mean age, 68 years; range, 22-94) were included in the study. Best-corrected visual acuity ranged from 6/9 to 6/120. Cystoid foveal oedema that contained cystoid spaces of various sizes was found in 21 (95%) of eyes; an intraretinal split was seen in 18 eyes (82%) and epiretinal membrane was detected in 16 eyes (73%).

The appearance of cystoid oedema at the residual fovea in symptomatic LMHs may explain in part a reduced visual acuity and/or metamorphopsia. The old notion on the low incidence of LMH progression may probably be related in part to (a) lower diagnostic accuracy before OCT was available and to (b) the already spontaneously peeled inner limiting membrane. Further studies are required to verify these observations, which may merit clinical and surgical considerations.