Clinical science 1 City Eye Centre, Brisbane, Australia; 2 Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; 3 Department of Ophthalmology, University of Queensland, Royal Brisbane Hospital, Brisbane, Australia Correspondence to: Dr J Chen, City Eye Centre, 10/ 135 Wickham Terrace, Brisbane Q 4000, Australia; eye@cityeye.com.au Accepted 11 June 2008 Published Online First 6 August 2008 This paper is freely available online under the BMJ Journals unlocked scheme, see http:// bjo.bmj.com/info/unlocked.dtl 1342 Clinical spectrum of lamellar macular defects including pseudoholes and pseudocysts defined by optical coherence tomography J C Chen,1,2 L R Lee1,3 ABSTRACT Objective: To present the clinical spectrum of lamellar macular defects and describe the different subtypes based on their optical coherence tomography (OCT) configuration and visual prognosis. Methods: The retrospective observational case series reviewed OCT scans of 92 eyes with lamellar macular defects. Lamellar macular defects were categorised into subtypes of macular pseudohole (MPH), lamellar macular hole (LMH) and foveal pseudocyst (FP) according to their OCT morphology. The defects were quantitatively characterised in terms of base diameter, depth and central foveal thickness, and examined for the presence of associated epiretinal membranes (ERM). Results: Visual acuity (VA) was significantly correlated with the central foveal thickness and depth of the lamellar defect. MPH was associated with better VA compared with LMH and FP. MPH was of a smaller base diameter and had a greater central foveal thickness than that of LMH and FP. Fifty-per cent of all lamellar defects had an associated ERM. Conclusions: Different profiles of lamellar macular defects were characterised and quantified by OCT. Deeper and wider lamellar defects were associated with poorer visual outcome. Such objective parameters lamellar macular defects are of value when explaining to patients regarding their decreased acuity. Future pro- spective investigations are required to study the natural history of lamellar defects of different aetiology and surgical indications. Optical coherence tomography (OCT) is an ima- ging modality that has revolutionised the way a myriad of ocular conditions are now diagnosed and monitored.1–8 OCT provides a cross-sectional tomo- graphy of the ocular microstructure in vivo and in real time, and the unprecedented high axial resolution (10 mm for standard OCT; 3–5 mm for ultra-high-resolution OCT) enables OCT the cap- ability to provide information that cannot be obtained with any other ophthalmic diagnostic techniques on the internal architecture of retinal pathology.1 In particular, direct visualisation of the vitreomacular interface with OCT imaging has significantly enhanced the understanding of the tractional forces causing structural changes to the retinal anatomy, as well as providing insight into the underlying aetiology and pathogenesis of the vitreomacular interface abnormalities, including macular hole,9–12 lamellar hole,13 14 macular pseudo- hole,14 epiretinal membrane15 16 and vitreomacular traction syndrome.13 17 Lamellar macular hole was first described by Gass in 1975 as a macular lesion that resulted from cystoid macular oedema.18 Since then, there has been much interest in defining the condition from other similar, yet distinct macular disorders, such as full-thickness macular holes, macular pseudo- holes and vitreomacular traction.9 11 13 A lamellar macular hole is by definition a partial thickness macular hole where the inner layers of the fovea are involved with traction and detached from the underlying cellular layers of the fovea. Lamellar macular holes typically appear as a round or irregular-shaped, well-circumscribed reddish lesion on biomicropscopy, but clinical detection of lamellar holes at an early stage can be difficult. Several studies have found that lamellar holes are underdiagnosed when conventional techniques are used.13 14 Only 28% (eight of 29 eyes) of lamellar holes diagnosed on OCT examination were detected clinically on fundus examination in the study of Haouchine et al,14 and 37% (seven of 19 eyes) in the study by Witkin et al13 With an OCT investigation, lamellar macular holes are easily diagnosed, and their characteristic features of an irregular foveal contour, break in the inner fovea, intraretinal split and an absence of a full-thickness foveal defect with intact foveal photoreceptors have been defined as a criterion for diagnosis.13 In addition to facilitating the diagnosis of lamellar macular holes, OCT has also been used to enhance the understanding of the aetiology and pathogenesis of the condition. Haouchine et al11 have identified foveal pseudocyst as a precursor to the development of both lamellar and macular hole formation. Lamellar holes are thought to be caused by de-roofing of the pseudocyst with preservation of the foveal base, while posterior extension of the pseudocyst leads to the formation of full-thickness macular holes.11 There have been very few OCT reports on lamellar macular holes, and our understanding of the definition, anatomical features, pathogenesis and surgical indications of this macular condition is limited. The purpose of this paper was to present the varied presentations of lamellar macular defects and describe features characterised by OCT that may be correlated to visual prognosis and the need for surgical intervention. MATERIALS AND METHODS We retrospectively reviewed the clinical records of 92 eyes of 81 consecutive patients (23 males and 58 females) who were referred to our centre for investigation of lamellar macular defects including Br J Ophthalmol 2008;92:1342–1346. doi:10.1136/bjo.2007.133041