Lamellar macular holes are partial-thickness defects of the macula with intraretinal separation between retinal layers causing loss of the foveal inner retinal layers.

Various subtypes of lamellar holes have been described, including those associated with the tractional epiretinal membrane, lamellar hole-associated epiretinal proliferation (LHEP), or degenerative changes associated with worse prognoses.

The clinical presentation is similar to those of full-thickness macular holes with blurriness and distortion of vision though usually to a lesser extent.

Surgical management is controversial. In symptomatic cases of lamellar holes with epiretinal membrane-related traction, surgical intervention may be successful in improving visual acuity. In those eyes with significant tissue loss, LHEP, and foveal atrophy with ellipsoid zone loss, surgical intervention is less commonly performed. Internal limiting membrane (ILM) peeling should be considered in surgical intervention due to the risk of postoperative full-thickness macular holes.

Lamellar holes have retinal tissue loss differentiating this entity from macular pseudoholes.

The hallmark optical coherence tomography (OCT) findings are the irregular foveal contour, loss of retinal tissue, intraretinal separation between the inner and outer retina, and intact foveal photoreceptors.

Tractional lamellar holes secondary to the epiretinal membrane typically have elevated foveal edges with most separation occurring between the outer nuclear and outer plexiform layers and including vertical hyperreflective bridges between spaces of hyporeflectivity, often with minimal actual tissue loss (Figure 33.1).