In a tractional lamellar macular hole, traction is observed above which layer?

In a tractional lamellar macular hole, traction is observed above which layer?

• A. ILM
• B. RNFL
• C. GCL
• D. OPL

Answer: (A)

Tangential traction from an epiretinal membrane acts at the vitreoretinal interface, specifically on the internal limiting membrane. The ILM is the boundary between the retina and the vitreous, so the pulling force is applied from above this layer. This is why a tractional lamellar macular hole shows distortion and splitting in the inner retina while the outer retina remains relatively intact—the traction is concentrated on the inner surface just above the ILM. The other layers listed lie deeper inside the retina and are not the site where the traction originates.

Tangential traction from an epiretinal membrane acts at the vitreoretinal interface, specifically on the internal limiting membrane. The ILM is the boundary between the retina and the vitreous, so the pulling force is applied from above this layer. This is why a tractional lamellar macular hole shows distortion and splitting in the inner retina while the outer retina remains relatively intact—the traction is concentrated on the inner surface just above the ILM. The other layers listed lie deeper inside the retina and are not the site where the traction originates.