University of Iowa Health Care

Ophthalmology and Visual Sciences

Lamellar Hole with Foveal Schisis

Contributor: Eric Chin MD

Photographer: Stefani Karakas, CRA

88-year-old male referred for evaluation of an epiretinal membrane and lamellar hole in the right eye. Patient had a history of a stroke with secondary visual field defects (quadrantanopsia). No acute vision changes. No metamorphopsia. No pain or irritation. No other complaints.

  • BCVA cc: OD 20/50; OS 20/25
  • IOP: 19 and 21

Discussed surgery versus observation. The patient elected for observation of his epiretinal membrane and lamellar hole.

Lamellar Hole with Foveal Schisis, fundus

Figure 1: OD: clear media; optic nerve cupping with peripapillary pigment; multiple intermediate and large drusen throughout macula and periphery; small lamellar hole at the fovea center and an epiretinal membrane worse between the fovea and superior arcades.

Lamellar Hole with Foveal Schisis,

Lamellar Hole with Foveal Schisis,

Figure 2: Cirrus OCT OD: epiretinal membrane with lamellar hole and foveal schisis.

Lamellar Holes

  • A lamellar hole represents an aborted (or partial thickness) macular hole.
  • Seen on slit lamp biomicroscopy as a round central inner retinal defect without thickening, cystic change, or subretinal fluid.
  • An overlying operculum is often seen (but not present in this case).
  • Mechanism is secondary to vitreofoveal separation with loss of the inner retinal layers, but with a preserved and intact outer photoreceptor layer.
  • Vision is usually good (20/20-20/30) and patients are often asymptomatic, when no other confounding variables such as an epiretinal membrane are present.
  • Fluorescein angiography shows no abnormal fluorescence.

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last updated: 11/25/2013
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