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Optical coherence tomography-based consensus definition for lamellar macular hole
  1. Jean Pierre Hubschman1,
  2. Andrea Govetto1,
  3. Richard F Spaide2,
  4. Ricarda Schumann3,
  5. David Steel4,
  6. Marta S Figueroa5,
  7. Jerry Sebag6,
  8. Alain Gaudric7,
  9. Giovanni Staurenghi8,
  10. Christos Haritoglou9,
  11. Kazuaki Kadonosono10,
  12. John T Thompson11,
  13. Stanley Chang12,
  14. Ferdinando Bottoni13,
  15. Ramin Tadayoni14
  1. 1 Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA
  2. 2 Manhattan Eye Ear, New York, New York, USA
  3. 3 Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
  4. 4 Ophthalmology, Sunderland Eye Infirmary, Sunderland, UK
  5. 5 Department of Ophthalmology, Ramon and Cajal Hospital, University of Alcala of Henares, Madrid, Spain
  6. 6 VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
  7. 7 Department of Ophthalmology, Lariboisière Hospital, University of Paris 7 Denis Diderot, Paris, France
  8. 8 Dipartimento di Scienze Cliniche Luigi Sacco, Eye Clinic, University of Milan, Milan, Italy
  9. 9 Department of Ophthalmology, Herzog Carl Theodor Clinic Munich, Munich, Germany
  10. 10 Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
  11. 11 Greater Baltimore Medical Center, Towson, Maryland, USA
  12. 12 Ophthalmology, Vagelos Columbia College of Physicians and Surgeons, New York, New York, USA
  13. 13 Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy
  14. 14 Ophthalmology, Lariboisière Hospital, Paris, France
  1. Correspondence to Dr Jean Pierre Hubschman, Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA 90095, USA; jphubschman{at}


Background A consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed.

Methods The panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions.

Results The panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle’s fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness.

Conclusions The use of the proposed definitions may provide uniform language for clinicians and future research.

  • macula
  • retina

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  • Contributors JPH and RT: ideation of the study, analysis, and interpretation of data for the work, drafting and revision of the work, final approval of the work. AG, RFS, RS, DS, MSF, JS, AG, GS, CH, KK, JTT, SC and FB: analysis, and interpretation of data for the work, drafting and revision of the work, final approval of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JPH: consultant for Alcon (Fort Wort, TX, USA), Allergan (Dublin, Ireland); Novartis (Basel, Switzerland), Bausch & Lomb (St Louis, USA); RFS: Consultant for Topcon Medical Systems (Tokyo, Japan). DS: consultant: Alcon (Fort Wort, Texas, USA), Orbit Biomedical (Ambler, Pennsylvania, USA) Zeiss (Oberkochen, Germany) Research funding: Alcon (Fort Wort, Texas, USA), Bayer (Leverkusen, Germany). MSF: consultant for Novartis (Basel, Switzerland), Alcon (Fort Wort, Texas, USA), Bayer (Leverkusen, Germany), Allergan (Dublin, Ireland), Hoffman LaRoche (Basel, Switzerland), Zeiss (Oberkochen, Germany); JS: consultant for Hoffman LaRoche (Basel, Switzerland); Zeiss (Oberkochen, Germany), EgbaVision; AG: personal fees from Novartis (Basel, Switzerland), personal fees from Bayer Healthcare (Leverkusen, Germany), personal fees from Thrombogenics; GS: financial support—Heidelberg Engineering (Heidelberg, Germany), Zeiss Meditec, Optovue, Optos, Centervue, Nidek, Novartis, Bayer, Allergan, Alcon; JTT: Genetech (Roche)—grant support and consultant Opthea—Grant support; EHR Command Center, LLC—Equity ownership; SC: Genentech—consultant (DSMC) Lowy Medical Research Institute—DSMC, uncompensated consultant Alcon—Travel reimbursement, FB: consultant for Novartis (Basel, Switzerland), Bayer (Leverkusen, Germany); RT: personal fees—Novartis (Basel, Switzerland), Bayer (Leverkusen, Germany), Roche (Basel, Switzerland), Genentech (San Francisco, California, USA), Allergan (Dublin, Ireland), Zeiss (Oberkochen, Germany), Alcon (Fort Wort, Texas, USA).

  • Patient consent for publication Not required.

  • Ethics approval The work was approved by the Institutional Review Board of the University of California Los Angeles, and the research project adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. This paper did use only deidentified data of several OCT images and other multimodal macular images.

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