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Foveal microstructure and visual function in patients with lamellar macular hole, epiretinal membrane foveoschisis or macular pseudohole



To compare the foveal microstructures, such as the prevalence of epiretinal proliferation (EP) and residual ellipsoid zone (EZ), in eyes with lamellar macular hole (LMH), epiretinal retinal membrane (ERM) foveoschisis and macular pseudohole (MPH), and to investigate the association of the foveal microstructure with visual functions.


In addition to the prevalence of EP, we calculated the residual EZ index within 1mm and 3 mm (rEZ1 and rEZ3) in all examined eyes. Comparisons were conducted to baseline characteristics (logMAR visual acuity [logMAR VA], metamorphopsia score [Mave], central retinal thickness [CRT], the prevalence of EP, rEZ1 and rEZ3) between MPH, ERM foveoschisis and LMH subgroups. The relationships (1) between logMAR VA and each of age, type (MPH, ERM foveoschisis and LMH), the prevalence of EP, rEZ1, rEZ3, spherical equivalent (SE) and CRT and (2) between Mave and each of variables were investigated.


Fifty-one eyes of 48 patients were enroled. The mean age was 65.2 ± 11.1 years. Ten eyes were diagnosed as LMH, 22 eyes as ERM foveoschisis and 19 eyes as MPH, respectively. There was a significant difference in CRT only between LMH and ERM foveoschisis (p = 0.023). There was a tendency toward significance in rEZ1 between LMH and ERM foveoschisis (p = 0.057), but not in rEZ3. The optimal model for logMAR VA included age, rEZ1, SE and CRT. On the other hand, the optimal model for Mave included the prevalence of EP, rEZ1 and SE.


Microstructural observations are useful to predict visual functions in LMH, ERM foveoshisis and MPH.

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Fig. 1: Representative OCT images of eyes with LMH, ERM foveoschisis or MPH.
Fig. 2: Measurement of residual EZ index.
Fig. 3: Visual functions in eyes with LMH, ERM foveoschisis or MPH.


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TI, YY, KeN and RyoA were responsible for writing the report, conducting the search, extracting and analysing data, interpreting results, updating reference lists. KoN, YT and ReiA contributed to extracting data. KK and MI provided feedback on the report.

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Correspondence to Tatsuya Inoue.

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Nakamura, K., Inoue, T., Nagura, K. et al. Foveal microstructure and visual function in patients with lamellar macular hole, epiretinal membrane foveoschisis or macular pseudohole. Eye 36, 2247–2252 (2022).

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