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Prevalence and characteristics of hyporeflective preretinal tissue in vitreomacular interface disorders
  1. Yuji Itoh1,2,
  2. Ashleigh L Levison1,2,
  3. Peter K Kaiser1,2,
  4. Sunil K Srivastava1,2,
  5. Rishi P Singh1,2,
  6. Justis P Ehlers1,2
  1. 1Ophthalmic Imaging Center, Cleveland, Ohio, USA
  2. 2Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Justis P Ehlers, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, i30, Cleveland, OH 44195, USA; ehlersj1{at}


Aims To assess prevalence and characteristics of hyporeflective preretinal tissue on spectral domain optical coherence tomography (SDOCT) in eyes with vitreomacular interface disorders.

Methods 4037 eyes (3195 patients) with diagnosis of lamellar macular hole (LMH), full-thickness macular hole (FTMH), epiretinal membrane (ERM) and vitreomacular traction were included. Quantitative analysis was performed including volume and area of the epiretinal proliferation, as well as the brightness of the hyporeflective band. Clinical characteristics were also collected and analysed.

Results A hyporeflective preretinal tissue layer was identified in 204 of 4037 eyes (5.1%); 162 eyes in LMH (79.4%), 23 eyes in FTMH (11.3%) and 19 eyes in ERM (9.3%). In LMH, the visual acuity was significantly different between the cases with and without epiretinal proliferation at the initial visit and the final visit, (p=0.012, 0.046, respectively). The maximum thickness, area, volume of hyporeflective preretinal tissue became significantly larger during the observation period (p<0.001). Brightness of the preretinal tissue (109.3±21.1 arbitrary unit) was close to the retinal ganglion cell layer (112.0±19.5) and the retinal outer plexiform layer (117.7±19.5).

Conclusions Hyporeflective preretinal tissue was found with significant frequency in eyes with LMH, FTMH and ERM, with a particularly high incidence in LMH. The increased presence of this tissue in cases of LMH may signify a particular subtype of LMH. More research is needed to better understand the implications of the presence of this tissue for visual and surgical outcomes.

  • Retina
  • Imaging
  • Pathology
  • Treatment Surgery
  • Physiology

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