Optical coherence tomography angiographic findings of lamellar macular hole: comparisons between tractional and degenerative subtypes

We investigated the microvascular changes in eyes with lamellar macular holes (LMHs) using optical coherence tomography angiography (OCTA), compare them between two subtypes of LMH. Tractional and degenerative LMH were differentiated based on the morphological characteristics of OCT. In OCTA images, foveal and parafoveal vessel density (VD) in the superficial and deep capillary plexus (SCP, DCP) and foveal avascular zone (FAZ) area were measured. Eyes that underwent vitrectomy for LMH were included in subgroup analysis. We analysed 63 LMH (42 tractional and 21 degenerative) eyes and 63 control eyes. Compared with degenerative LMH, tractional LMH had better BCVA ( p = 0.010), smaller FAZ area ( p = 0.001), and higher foveal VD in the SCP ( p = 0.130) and DCP ( p = 0.002). In degenerative LMH, better BCVA was associated with greater foveal VD in the SCP ( p = 0.040) and DCP ( p = 0.005), and parafoveal VD in the SCP ( p = 0.006). In subgroup analysis, only the tractional LMH group showed significant increases in foveal and parafoveal VDs in the SCP after vitrectomy ( p = 0.001 and p = 0.026, respectively). Significant differences in microvascular changes were noted between tractional and degenerative LMH, suggesting that two subtypes are distinct pathogenetic entities.