Association Between Epiretinal Membrane-Induced Retinal Traction and the Natural Course of Lamellar Macular Hole

PURPOSE: To evaluate the effect of epiretinal membrane (ERM)-induced retinal traction on functional and anatomical changes of lamellar macular hole (LMH). METHODS: This retrospective study included patients with LMH followed for at least 12 months without surgery. Best-corrected visual acuity (BCVA), M-CHARTS-assessed metamorphopsia, and optical coherence tomography (OCT) parameters were evaluated. ERM-induced retinal traction was assessed using B-scan and en face OCT images, with maximum depth of retinal folds (MDRF) quantified as an indicator of retinal traction strength. Annual rates of change in visual function and OCT parameters were compared between eyes with and without ERM-induced retinal traction. RESULTS: Thirty-six eyes were analyzed. During a mean follow-up of 46.4 ± 28.4 months, BCVA and metamorphopsia worsened, accompanied by foveal cavity enlargement, increased epiretinal proliferation thickness and ellipsoid zone disruption length, and decreased minimum retinal thickness (all P < 0.05). Eyes with ERM-induced retinal traction demonstrated significantly faster functional and anatomical deterioration than those without traction. MDRF showed significant correlations with worsening rates of BCVA, metamorphopsia, foveal cavity enlargement, and retinal thinning. CONCLUSION: ERM-induced retinal traction was associated with accelerated functional and anatomical deterioration in LMH. Quantitative assessment of retinal traction may facilitate the identification of LMH at higher risk of progression.