Macular Pigment Optical Density Levels Reflect Retinal Remodeling in Lamellar Macular Holes

Purpose: To quantify macular pigment optical density (MPOD) in eyes with lamellar macular holes (LMHs) diagnosed according to contemporary optical coherence tomography (OCT) criteria and to evaluate its relationship with structural and functional parameters. Methods: This prospective observational study screened 66 patients with unilateral LMH. All participants underwent comprehensive ophthalmic examination, spectral-domain OCT, and MPOD assessment using heterochromatic flicker photometry. Central foveal thickness (CFT), best-corrected visual acuity (BCVA) and OCT features were recorded. Paired inter-eye comparisons and linear mixed-effects regression analyses were performed. Results: Forty-eight patients (48 LMH eyes and 48 contralateral healthy fellow eyes) were included. CFT was significantly reduced in LMH eyes compared with fellow eyes (177.2 ± 13.6 µm vs. 251.9 ± 5.9 µm; P < 0.0001). MPOD was lower in LMH eyes than in fellow eyes (0.508 ± 0.096 vs. 0.583 ± 0.097; P < 0.0001), and BCVA was worse (P < 0.0001). In multivariable analysis restricted to LMH eyes, MPOD was independently associated with age (β = -0.010 per year; 95% CI, -0.018 to -0.003; P = 0.0085) and BCVA (β = -0.494 per logMAR; 95% CI, -0.910 to -0.079; P = 0.0207), but not with CFT (P = 0.1438). In eyes with marked foveal thinning (CFT < 180 µm; n = 26), MPOD was reduced (P = 0.0065). Conclusions: MPOD is reduced in eyes with OCT-defined LMH and is associated with BCVA. As MP is preferentially localized within the Müller cell cone, altered MPOD may reflect foveal remodeling or MP redistribution related to EP.