Lamellar Macular Hole

A lamellar macular hole is a partial thickness loss of foveal tissue and can arise from varying etiologies including an abortive process in full-thickness macular hole formation, in the instance of an inner cyst wall rupture in cystoid macular edema, and in the presence of contraction of a perifoveal epiretinal membrane and/or vitreomacular traction/adhesion (Ko J et al., Acta Ophthalmol 95(3):e221, 2016). The lamellar macular hole is diagnosed with a detailed fundus evaluation in conjunction with optical coherence tomography (OCT). Typically the patient will be asymptomatic or exhibit a small reduction in vision. Inner lamellar holes can be successfully managed by the clinician with frequent dilated fundus examination and serial OCT to establish stability. Symptomatic and progressive inner lamellar macular holes may be referred for surgical management via pars plana vitrectomy, epiretinal membrane/internal limiting membrane peel, and gas tamponade. This case explores one such presentation and delves into management options.