Which statement best describes a tractional lamellar macular hole on OCT?

Which statement best describes a tractional lamellar macular hole on OCT?

• A. Macular hole that involves full-thickness rupture of the retina.
• B. Macular hole that begins to lift the retina normally between OPL and ONL with traction above the ILM.
• C. Pseudo macular hole: not full thickness, no lifting between retinal layers.
• D. Degenerative lamellar macular hole: not full thickness, but begins to progress laterally out into sides of retinal layers.

Answer: (B)

Tractional lamellar macular hole is a partial-thickness macular defect caused by tangential traction from a surface epiretinal membrane (above the ILM), leading to foveal elevation without a full-thickness retinal break. On OCT you’d see thinning and a partial defect at the fovea, with the outer retina (typically near the boundary between the outer plexiform layer and outer nuclear layer) separated, while the inner and outer retinal layers overall remain present. The key is that there is lifting and a hole that does not extend through all retinal layers, driven by traction from above the ILM. This distinguishes it from full-thickness holes (which go through all layers) and from pseudo-holes or degenerative LMH, which have different traction and tissue-loss patterns.

Tractional lamellar macular hole is a partial-thickness macular defect caused by tangential traction from a surface epiretinal membrane (above the ILM), leading to foveal elevation without a full-thickness retinal break. On OCT you’d see thinning and a partial defect at the fovea, with the outer retina (typically near the boundary between the outer plexiform layer and outer nuclear layer) separated, while the inner and outer retinal layers overall remain present. The key is that there is lifting and a hole that does not extend through all retinal layers, driven by traction from above the ILM. This distinguishes it from full-thickness holes (which go through all layers) and from pseudo-holes or degenerative LMH, which have different traction and tissue-loss patterns.