Mixed pathophysiologies of lamellar macular holes and related diseases: a multimodal optical coherence tomography-based study

To investigate the characteristics of mixed pathophysiologies in lamellar macular holes (LMH) and related diseases using multimodal optical coherence tomography (OCT). Overall, 126 eyes diagnosed with LMH, epiretinal membrane foveoschisis (ERM-FS), or macular pseudohole (MPH) using the horizontal B-scan image according to the definition proposed by Hubschman et al. in 2020 were analyzed using multimodal OCT imaging including horizontal and vertical 5-line B-scan, radial scan, and macular three-dimensional volume scan images. If at least two diagnostic criteria for LMH, ERM-FS, or MPH were satisfied in these scans, the patient was diagnosed as having a "mixed type.” Retinal traction force was quantitatively evaluated by measuring the maximum depth of the retinal folds (MDRF) using en-face images. Mixed types constituted 34.1% of the cases. The LMH-related mixed group demonstrated intermediate characteristics between the ERM-FS/MPH and true LMH groups in terms of retinal traction and LMH-specific features and had a significant positive correlation between the MDRF and mean M-CHARTS scores (P = 0.034). A thorough OCT analysis is necessary to accurately diagnose LMH and related diseases. A significant positive correlation was observed between the MDRF and the degree of metamorphopsia in the LMH-related mixed group.