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Lamellar Hole Associated With Prominent Intraretinal Vessels.

Lamellar hole–associated epiretinal proliferation was recently described by Pang et al as a new form of epiretinal proliferation, defined on spectral domain optical coherence tomography imaging as a thick material of homogenous medium reflectivity located on the epiretinal surface at the margin of lamellar retinal defects, without any tractional effects. In their report, this infrequent proliferation demonstrated contiguity with the middle retinal layers and conformed to the adjacent retinal anatomy, and morphologic stability was demonstrated in 97% of eyes for up to 63 months of retrospective follow-up. A 85-year-old woman with no history of diabetes, hypertension, or inflammatory diseases presented with a diagnosis of macular hole. She complained of vision changes for several months. The best-corrected visual acuity was 20/80. Fundus examination showed the macular hole, some macular pigment changes without hemorrhage. Fluorescein and indocyanine green angiography (HRA; Heidelberg Engineering, Heidelberg, Germany) showed a well-defined macular neovascular network (Figure 1, B and C). Optical coherence tomography showed a lamellar hole–associated epiretinal proliferation, with several hyperreflective roundish structures Fig. 1. Optical coherence tomography angiography (A) at the segmentation of the retinal deep vascular plexus permits a good visualization of the neovascular network, at the retinal deep plexus level. Fluorescein angiography with early (B) and late (C) phases show a well-defined macular neovascular network. Optical coherence tomography B-scan (D and E): the green lines correspond to the automatic segmentation of the retinal deep vascular plexus (D) for optical coherence tomography angiography. Optical coherence tomography shows multiple hyperreflective roundish structures inside the lamellar hole–associated epiretinal proliferation, corresponding to the neovascular network. The hyperreflective material seen in the central mound appears as a homogenous material, lying on the epiretinal surface, contiguous with the middle retinal layers and completely covers the center of the lamellar hole, with variation of thickness. There is no sign of traction.