Vogt Denise, Wachtlin Joachim, Priglinger Siegfried G, Schumann Ricarda G
Augenklinik der Universität München, Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336, München, Deutschland.
Augenabteilung, Sankt Gertrauden Krankenhaus, Berlin, Deutschland.
Ophthalmologe. 2019 Nov;116(11):1020-1025. doi: 10.1007/s00347-019-00966-w.
In recent years the high resolution of optical coherence tomography (SD-OCT) has led to a more exact and detailed imaging of different morphological types of lamellar macular holes (LMH). This resulted in new knowledge on the pathogenesis, morphology and progression of the disease; however, this also resulted in a lack of clarity in the terminology and in particular led to uncertainty in the treatment of these patients in clinical practice.
This article gives an overview on the morphological characteristics and treatment indications for LMH with the aim of enabling a clear differentiation compared to other morphological alterations in traction macular pathologies.
The evaluation is based on the current literature and own study data from the Department of Ophthalmology at the University of Munich, Germany.
In eyes with LMH different morphological forms can be seen in SD-OCT. In addition to the known diagnostic criteria of irregular foveal contour, intraretinal splitting and defect of the inner foveal layers, the occurrence and characteristics of epiretinal tissue as well as the occurrence of photoreceptor layer defects can be evaluated.
Further development of imaging techniques, such as SD-OCT led to improved visualization of different types of LMH. Decisions on treatment should be based on subjective complaints, best corrected visual acuity (BCVA), the clinical course, the presence of defects of the ellipsoid zone, occurrence and characteristics of epiretinal tissue. In cases of progression of symptoms and/or traction by the epiretinal tissue, an early surgical procedure has a good prognosis for functional and anatomical rehabilitation.
近年来，光学相干断层扫描（SD-OCT）的高分辨率使得对不同形态类型的板层黄斑裂孔（LMH）能够进行更精确和详细的成像。这为该疾病的发病机制、形态学和进展带来了新的认识；然而，这也导致了术语方面的不清晰，尤其是在临床实践中对这些患者的治疗产生了不确定性。
本文概述了LMH的形态学特征和治疗指征，旨在与牵引性黄斑病变中的其他形态学改变进行明确区分。
评估基于当前文献以及德国慕尼黑大学眼科系的自身研究数据。
在患有LMH的眼中，SD-OCT可观察到不同的形态形式。除了已知的不规则黄斑中心凹轮廓、视网膜内劈裂和黄斑中心凹内层缺陷的诊断标准外，还可评估视网膜前组织的出现情况和特征以及光感受器层缺陷的出现情况。
成像技术（如SD-OCT）的进一步发展使得不同类型的LMH可视化得到改善。治疗决策应基于主观症状、最佳矫正视力（BCVA）、临床病程、椭圆体带缺陷的存在、视网膜前组织的出现情况和特征。在症状进展和/或视网膜前组织产生牵引的情况下，早期手术对功能和解剖学康复具有良好的预后。
