Pseudohole (OCT Study)

Macular pseudohole and the corresponding OCT study. Note the overlying epiretinal membrane which causes wrinkling of the overlying retina 

  • Retinal lesion that simulates macular hole without actual tissue loss.

Clinical features:

  • Altered light reflex and darker appearance of the fovea
  • Steepening of the normal foveal depression
  • Most commonly seen in association with epiretinal membrane contraction, vitreomacular traction syndromes, proliferative diabetic retinopathy, rhegmatogenous retinal detachment, intraocular inflammation, trauma and venous occlusive disease
  • Optical coherent tomography (OCT) demonstrates:
    • Steepening of foveal contour
    • Full thickness retinal tissue is present
    • Reflective epiretinal membrane layer is present on the surface of the retina
  • Fluorescein angiography often reveals normal fluorescence except if traction-induced retinal vascular disruption present.

Management:

  • Treatment of the underlying causes of epiretinal membrane.
  • Observation of progressive contraction, which may lead to macular edema.
  • Surgical vitrectomy to peel the epiretinal membrane may be indicated in patients with worsening vision of 20/80 or less.